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Journal of Gastrointestinal Surgery

, Volume 14, Issue 11, pp 1701–1708 | Cite as

Redefining Mortality After Pancreatic Cancer Resection

  • James Edward Carroll
  • Jillian K. Smith
  • Jessica P. Simons
  • Melissa M. Murphy
  • Sing Chau Ng
  • Shimul A. Shah
  • Zheng Zhou
  • Jennifer F. TsengEmail author
2010 SSAT Plenary Presentation

Abstract

Introduction

Distinct outcome measures such as in-hospital and 30-day mortality have been used to evaluate pancreatectomy results. We posited that these measures could be compared using national data, providing more precision for evaluating published outcomes after pancreatectomy.

Methods

Patients undergoing resection for pancreatic cancer were identified from the linked SEER-Medicare databases (1991–2002). Mortality was analyzed and trend tests were utilized to evaluate risk of death within ≤60 days of resection and from 60 days to 2 years post-resection. Univariate analysis assessed patient characteristics such as race, gender, marital status, socioeconomic status, hospital teaching status, and complications.

Results

One thousand eight hundred forty-seven resected patients were identified: 7.7% (n = 142) died within the first 30 days, 83.6% of whom died during the same hospitalization. Postoperative in-hospital mortality was 8.1% (n = 150), 79% of which was within 30 days, greater than 90% of which was within 60 days. Risk of death decreased significantly over the first 60 days (P < 0.0001). After 60 days, the risk did not decrease through 2 years (P = 0.8533). Univariate analysis showed no difference between the two groups in terms of race, gender, marital status, and socioeconomic status, but patients dying within 60 days were more likely to have experienced a complication (41.1% vs. 17.0%, P < 0.0001).

Conclusions

In-hospital and 30-day mortality after resection for cancer are similar nationally; thus, comparing mortality utilizing these measures is acceptable. After a 60-day post-resection window of increased mortality, mortality risk then continues at a constant rate over 2 years, suggesting that mortality after pancreatectomy is not limited to early (“complication”) and late (“cancer”) phases. Determining ways to decrease perioperative mortality in the 60-day interval will be critical to improving overall survival.

Keywords

Pancreatic adenocarcinoma Outcomes Resection Survival SEER-Medicare 

Notes

Acknowledgments

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

We thank Bridget A. Neville, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, for her statistical expertise.

This work was supported by the Pancreatic Cancer Alliance, the American Surgical Association Foundation, the Howard Hughes Early Career Award, and an American Cancer Society Institutional Research Grant (all to Jennifer F. Tseng).

Authors’ Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • James Edward Carroll
    • 1
  • Jillian K. Smith
    • 1
  • Jessica P. Simons
    • 1
  • Melissa M. Murphy
    • 1
  • Sing Chau Ng
    • 1
  • Shimul A. Shah
    • 1
  • Zheng Zhou
    • 1
  • Jennifer F. Tseng
    • 1
    Email author
  1. 1.Department of Surgery, Surgical Outcomes Analysis and Research (SOAR)University of Massachusetts Medical SchoolWorcesterUSA

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