TY - JOUR
T1 - Improved perioperative outcomes with minimally invasive distal pancreatectomy
T2 - Results from a population-based analysis
AU - Tran Cao, Hop S.
AU - Lopez, Nicole
AU - Chang, David C.
AU - Lowy, Andrew M.
AU - Bouvet, Michael
AU - Baumgartner, Joel M.
AU - Talamini, Mark A.
AU - Sicklick, Jason K.
PY - 2014/3
Y1 - 2014/3
N2 - IMPORTANCE: Interest in minimally invasive distal pancreatectomy (MIDP) has grown in recent years, but currently available data are limited. Greater insight into application patterns and outcomesmay be gained from a national database inquiry. OBJECTIVES: To study trends in the use of MIDP and compare the short-term outcomes of MIDP with those of open distal pancreatectomy. DESIGN, SETTING, AND PARTICIPANTS: Population-based retrospective cohort study evaluating perioperative outcomes and hospital charge measures for distal pancreatectomy, comparing the surgical approaches and adjusting for patient- and hospital-level factors, among patients undergoing elective distal pancreatectomy from 1998 to 2009 in the Nationwide Inpatient Sample in a 20% stratified sample of all US hospitals. MAIN OUTCOMES AND MEASURES: In-hospital mortality, rates of perioperative complications and splenectomy, total charges, and length of stay. RESULTS: A total of 8957 distal pancreatectomies were included in this analysis, of which 382 (4.3%) were MIDPs. On a national level, this projected to 42 320 open distal pancreatectomies and 1908 MIDPs. The proportion of distal pancreatectomies performed via minimally invasive approaches tripled between 1998 and 2009, from 2.4%to 7.3%. The groups were comparable for sex and comorbidity profiles, while patients who underwent MIDP were 1.5 years older. On multivariate analysis, MIDP was associated with lower rates of overall predischarge complications, including lower incidences of postoperative infections and bleeding complications, as well as a shorter length of stay by 1.22 days. There were no differences in rates of in-hospital mortality, concomitant splenectomy, or total charges. CONCLUSIONS AND RELEVANCE: This population-based study of MIDP reveals that the application of this approach has tripled in practice and provides strong evidence that MIDP has evolved into a safe option in the treatment of benign and malignant pancreatic diseases.
AB - IMPORTANCE: Interest in minimally invasive distal pancreatectomy (MIDP) has grown in recent years, but currently available data are limited. Greater insight into application patterns and outcomesmay be gained from a national database inquiry. OBJECTIVES: To study trends in the use of MIDP and compare the short-term outcomes of MIDP with those of open distal pancreatectomy. DESIGN, SETTING, AND PARTICIPANTS: Population-based retrospective cohort study evaluating perioperative outcomes and hospital charge measures for distal pancreatectomy, comparing the surgical approaches and adjusting for patient- and hospital-level factors, among patients undergoing elective distal pancreatectomy from 1998 to 2009 in the Nationwide Inpatient Sample in a 20% stratified sample of all US hospitals. MAIN OUTCOMES AND MEASURES: In-hospital mortality, rates of perioperative complications and splenectomy, total charges, and length of stay. RESULTS: A total of 8957 distal pancreatectomies were included in this analysis, of which 382 (4.3%) were MIDPs. On a national level, this projected to 42 320 open distal pancreatectomies and 1908 MIDPs. The proportion of distal pancreatectomies performed via minimally invasive approaches tripled between 1998 and 2009, from 2.4%to 7.3%. The groups were comparable for sex and comorbidity profiles, while patients who underwent MIDP were 1.5 years older. On multivariate analysis, MIDP was associated with lower rates of overall predischarge complications, including lower incidences of postoperative infections and bleeding complications, as well as a shorter length of stay by 1.22 days. There were no differences in rates of in-hospital mortality, concomitant splenectomy, or total charges. CONCLUSIONS AND RELEVANCE: This population-based study of MIDP reveals that the application of this approach has tripled in practice and provides strong evidence that MIDP has evolved into a safe option in the treatment of benign and malignant pancreatic diseases.
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U2 - 10.1001/jamasurg.2013.3202
DO - 10.1001/jamasurg.2013.3202
M3 - Article
C2 - 24402232
AN - SCOPUS:84897843753
SN - 2168-6254
VL - 149
SP - 237
EP - 243
JO - JAMA surgery
JF - JAMA surgery
IS - 3
ER -