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Analysis of pancreatic pseudocyst drainage procedural outcomes: a population based study

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Abstract

Background

A pancreatic pseudocyst is a collection of fluid surrounded by a well-defined wall that contains no solid material. Studies on outcomes of pancreatic pseudocyst drainage have largely been limited to small cohorts. This study aims to take a population based approach to evaluate differences in inpatient outcomes among laparoscopic, percutaneous, and endoscopic drainage for pancreatic pseudocysts.

Methods

The National Inpatient Sample database was used to identify inpatient stays for pancreatic pseudocysts in which a single drainage approach was conducted. Baseline characteristic differences were compared with Rao-Scott chi squared and Mann–Whitney U tests. Propensity score matching controlling for clinical and demographic covariates followed by multivariable regression was used to pairwise compare drainage outcomes. Primary outcomes were length of stay, total charge, mortality, and disposition. Secondary outcomes were procedure related complication rates.

Results

Among a total of 35,640 weighted pancreatic pseudocyst cases, 3235 underwent drainage via a single procedure. Percutaneous was the most frequent drainage method performed (44.5%) and was more likely to be performed at nonteaching hospitals than laparoscopic (17% vs 9%, p = 0.04). Percutaneous drainage was associated with longer LOS (aIRR 1.42, 95% CI 1.07–1.86, p = 0.01) versus endoscopic and lower rates of routine disposition (aOR 0.45, 95% CI 0.23–0.89, p = 0.02) relative to endoscopic and laparoscopic (aOR 0.41, 95% CI 0.27–0.61, p < 0.01) drainage. There were no differences in primary outcomes in laparoscopic versus endoscopic drainage. Percutaneous drainage was associated with higher rates of septic shock than laparoscopic drainage (aOR 2.59, 95% CI 1.15–5.82, p = 0.02).

Conclusions

Endoscopic and laparoscopic pancreatic pseudocyst drainage are associated with the least short term procedure related complications and more favorable in-hospital outcomes compared to percutaneous approaches. However, percutaneous drainage was the most commonly performed method in the 2017 NIS database.

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Authors and Affiliations

  1. Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA

    Amrita Chawla & Vishnu Prasath

  2. Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ, USA

    Amrita Chawla, Faiz Afridi & Sushil Ahlawat

  3. Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA

    Ravi Chokshi

  4. Jersey City, NJ, USA

    Amrita Chawla

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  1. Amrita Chawla
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Correspondence to Amrita Chawla.

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Amrita Chawla, Faiz Afridi, Vishnu Prasath, Ravi Chokshi, and Sushil Ahlawat have no conflicts of interest or financials ties to disclose.

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Chawla, A., Afridi, F., Prasath, V. et al. Analysis of pancreatic pseudocyst drainage procedural outcomes: a population based study. Surg Endosc 37, 156–164 (2023). https://doi.org/10.1007/s00464-022-09427-z

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  • DOI: https://doi.org/10.1007/s00464-022-09427-z

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