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Operative Trends for Pancreatic Diseases in the USA: Analysis of the Nationwide Inpatient Sample from 1998–2011

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

The epidemiology of pancreatic diseases is changing. Our aim was to determine the change in indications, frequency, and type of operations being performed for primary pancreatic diseases in the USA. Using the Nationwide Inpatient Sample, all patients aged ≥18 years who underwent pancreatic operations for a primary pancreatic indication between 1998–2011 were identified. Age- and sex-adjusted rates per million adult population were calculated using the 2010 US population as reference. Changes in patient characteristics and outcomes were analyzed. Of 151,454 operations, 82 % were resections and 64 % were performed for tumors (malignant 52 %, benign 12 %). Operative rates/million population increased from 41.36 in 1998 to 62.3 in 2011. Population rates increased significantly for distal pancreatectomy, but decreased significantly for drainage procedures (p < 0.05). Additionally, operative rates increased significantly for tumors and cysts/pseudocysts, but decreased significantly for acute pancreatitis (p < 0.05). During this period, mean age, and comorbidity burden for patients undergoing pancreatic operations increased significantly, while their length of hospital stay and in-hospital mortality decreased significantly (p trend <0.05). The number of pancreatic operations performed in the USA is increasing. Although being offered to older patients with more comorbidities, surgeries are being performed with increasing safety and better outcomes.

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References

  1. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144:1252-61.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gardner TB, Glass LM, Smith KD, Ripple GH, et al. Pancreatic cyst prevalence and the risk of mucin-producing adenocarcinoma in US adults. Am J Gastroenterol 2013;108:1546-50.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 2006;33:323-30.

    Article  PubMed  Google Scholar 

  4. Yang AL, Vadhavkar S, Singh G, Omary MB. Epidemiology of alcohol-related liver and pancreatic disease in the United States. Arch Intern Med 2008;168:649-56.

    Article  PubMed  Google Scholar 

  5. Geer RJ, Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 1993;165:68-72; discussion 72-3.

    Article  CAS  PubMed  Google Scholar 

  6. Gooszen HG, Besselink MG, van Santvoort HC, Bollen TL. Surgical treatment of acute pancreatitis. Langenbecks Arch Surg 2013;398:799-806.

    Article  PubMed  Google Scholar 

  7. Paulson AS, Tran Cao HS, Tempero MA, Lowy AM. Therapeutic advances in pancreatic cancer. Gastroenterology 2013;144:1316-26.

    Article  CAS  PubMed  Google Scholar 

  8. Talukdar R, Nageshwar Reddy D. Endoscopic therapy for chronic pancreatitis. Curr Opin Gastroenterol 2014;30:484-9.

    Article  PubMed  Google Scholar 

  9. Trikudanathan G, Attam R, Arain MA, Mallery S, et al. Endoscopic interventions for necrotizing pancreatitis. Am J Gastroenterol 2014;109:969-81; quiz 982.

    Article  PubMed  Google Scholar 

  10. Zureikat AH, Hogg ME, Zeh HJ, 3rd. The utility of the robot in pancreatic resections. AdvSurg 2014;48:77-95.

    Google Scholar 

  11. Ejaz A, Sachs T, He J, Spolverato G, et al. A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the Nationwide Inpatient Sample. Surgery 2014;156:538-47.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Eppsteiner RW, Csikesz NG, McPhee JT, Tseng JF, et al. Surgeon volume impacts hospital mortality for pancreatic resection. Ann Surg 2009;249:635-40.

    Article  PubMed  Google Scholar 

  13. Hill JS, McPhee JT, Whalen GF, Sullivan ME, et al. In-hospital mortality after pancreatic resection for chronic pancreatitis: population-based estimates from the nationwide inpatient sample. J Am Coll Surg 2009;209:468-76.

    Article  PubMed  Google Scholar 

  14. McPhee JT, Hill JS, Whalen GF, Zayaruzny M, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246-53.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rosales-Velderrain A, Bowers SP, Goldberg RF, Clarke TM, et al. National trends in resection of the distal pancreas. World J Gartroenterol 2012;18:4342-9.

    Article  Google Scholar 

  16. Tran Cao HS, Lopez N, Chang DC, Lowy AM, et al. Improved perioperative outcomes with minimally invasive distal pancreatectomy: results from a population-based analysis. JAMA Surg 2014;149:237-43.

    Article  PubMed  Google Scholar 

  17. Enomoto LM, Gusani NJ, Dillon PW, Hollenbeak CS. Impact of surgeon and hospital volume on mortality, length of stay, and cost of pancreaticoduodenectomy. J Gastrointest Surg 2014;18:690-700.

    Article  PubMed  Google Scholar 

  18. Wormer BA, Swan RZ, Williams KB, Bradley JF, 3rd, et al. Outcomes of pancreatic debridement in acute pancreatitis: analysis of the nationwide inpatient sample from 1998 to 2010. Am J Surg 2014;208:350-62.

    Article  PubMed  Google Scholar 

  19. Healthcare Cost and Utilization Project (HCUP). Available at: http://www.ahrq.gov/research/data/hcup/index.html. Accessed 2.2.2015.

  20. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8-27.

    Article  CAS  PubMed  Google Scholar 

  21. Smith-Bindman R, Miglioretti DL, Johnson E, Lee C, et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA 2012;307:2400-9.

    Article  CAS  PubMed  Google Scholar 

  22. Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 2010;7:e1000267.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Muller SA, Hartel M, Mehrabi A, Welsch T, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg 2009;13:784-92.

    Article  PubMed  Google Scholar 

  24. Tseng JF, Raut CP, Lee JE, Pisters PW, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004;8:935-49; discussion 949-50.

    Article  PubMed  Google Scholar 

  25. Yekebas EF, Bogoevski D, Cataldegirmen G, Kunze C, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg 2008;247:300-9.

    Article  PubMed  Google Scholar 

  26. Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012;307:1053-61.

    Article  CAS  PubMed  Google Scholar 

  27. Besselink MG, Verwer TJ, Schoenmaeckers EJ, Buskens E, et al. Timing of surgical intervention in necrotizing pancreatitis. Arch Surg 2007;142:1194-201.

    Article  PubMed  Google Scholar 

  28. Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, et al. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. Am J Roentgenol 1998;170:969-75.

    Article  CAS  Google Scholar 

  29. Gardner TB, Chahal P, Papachristou GI, Vege SS, et al. A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc 2009;69:1085-94.

    Article  PubMed  Google Scholar 

  30. Kulkarni S, Bogart A, Buxbaum J, Matsuoka L, et al. Surgical transgastric debridement of walled off pancreatic necrosis: an option for patients with necrotizing pancreatitis. Surg Endosc 2015;29:575-82.

    Article  PubMed  Google Scholar 

  31. Kumar N, Conwell DL, Thompson CC. Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization. Pancreas 2014;43:1334-9.

    Article  PubMed  Google Scholar 

  32. Sleeman D, Levi DM, Cheung MC, Rahnemai-Azar A, et al. Percutaneous lavage as primary treatment for infected pancreatic necrosis. J Am Coll Surg 2011;212:748-52; discussion 752-4.

    Article  PubMed  Google Scholar 

  33. Law R, Baron TH. Endoscopic management of pancreatic pseudocysts and necrosis. Expert Rev Gastroenterol Hepatol 2015;9:167-75.

    Article  CAS  PubMed  Google Scholar 

  34. Dumonceau JM, Delhaye M, Tringali A, Dominguez-Munoz JE, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2012;44:784-800.

    Article  PubMed  Google Scholar 

  35. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg 2015;220:530-6.

    Article  PubMed  Google Scholar 

  36. Winter JM, Brennan MF, Tang LH, D’Angelica MI, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol 2012;19:169-75.

    Article  PubMed  Google Scholar 

  37. Winter JM, Cameron JL, Campbell KA, Arnold MA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006;10:1199-210; discussion 1210-1.

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Authorship Criteria and Contributions

Study design: AD, DY

Data analysis: AD, SM

Data interpretation: All authors

Drafting the manuscript: AD, AZ, DY

Revising the manuscript, final approval of the version to be published: All authors

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Anwar Dudekula

  2. Division of Gastroenterology & Hepatology, Department of Internal Medicine, St. Louis University, St. Louis University, MO, USA

    Satish Munigala

  3. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Amer H. Zureikat

  4. Division of Gastroenterology & Hepatology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Dhiraj Yadav

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  1. Anwar Dudekula
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  2. Satish Munigala
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  3. Amer H. Zureikat
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  4. Dhiraj Yadav
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Correspondence to Dhiraj Yadav.

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Dudekula, A., Munigala, S., Zureikat, A.H. et al. Operative Trends for Pancreatic Diseases in the USA: Analysis of the Nationwide Inpatient Sample from 1998–2011. J Gastrointest Surg 20, 803–811 (2016). https://doi.org/10.1007/s11605-015-3067-x

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  • DOI: https://doi.org/10.1007/s11605-015-3067-x

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