In hospital outcomes after pancreatectomies: an analysis of a national database from 1996 to 2004.
BACKGROUND
National complication rates following pancreatectomies have not been systematically reported.


METHODS
We queried the national hospital discharge survey (NHDS) database to analyze risk factors associated with mortality and length of stay after pancreatectomies.


RESULTS
An estimated 49,346 pancreatectomies were performed from 1996 to 2004. The national mortality rate is 9% with an average length of stay 15 days (Interquartile range 10-23) while the morbidity is 35%. Size of the hospital (<300 beds) (OR 2.76 (95% CI 1.14-6.70, P = 0.02)), post-operative pulmonary edema (OR 2.80 (95% CI 1.28-6.12, P = 0.01)) and sepsis (OR 5.22 (95% CI 1.94-14.11, P = 0.001)) are associated with higher mortality. Patients in larger hospitals (>500 beds) (Rate ratio 0.87 (95% CI 0.83-0.91, P < 0.001)) had a shorter hospital stay. Temporal trends reveal a shorter hospital length of stay in 2004 (Rate ratio 0.86 (95% CI 0.78-0.94, P = 0.001)) as compared to 1996. The percentage of pancreatectomies performed at larger hospitals in 1996 (40%) and 2004 (41%) has remained constant.


CONCLUSIONS
The national mortality and morbidity rates after pancreaticoduodenectomy are 9% and 35%, respectively. Larger hospital size and absence of pulmonary edema and sepsis improves mortality. Larger hospitals have better outcomes although the trend for regionalization is not apparent.
Turaga
Kiran
K
Department of Surgery, Creighton University Medical Center, Omaha, Nebraska, USA.
Kaushik
Manas
M
Forse
R Armour
RA
Sasson
Aaron R
AR
D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010182:Pancreatic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors