National complication rates after pancreatectomy: beyond mere mortality.
BACKGROUND
National studies on in-hospital pancreatic outcomes have focused on mortality. Non-fatal morbidity affects a greater proportion of patients.


METHODS
The Nationwide Inpatient Sample 1998-2006 was queried for discharges after pancreatectomy. Rates of major complications (myocardial infarction, aspiration pneumonia, pulmonary compromise, perforation, infection, deep vein thrombosis/pulmonary embolism, hemorrhage, or reopening of laparotomy) were assessed. Predictors of complication(s) were evaluated using logistic regression. Their independent effect on in-hospital mortality, length of stay, and discharge disposition was assessed.


RESULTS
Of 102,417 patient discharges, 22.7% experienced a complication. Complication rates did not decline significantly over time, while mortality rates did. Independent predictors of complications included age >or=75 [referent, 19-39; adjusted odds ratio (OR) 1.34, 95% confidence interval (CI) 1.2-1.5, p < 0.0001], total pancreatectomy (vs proximal, OR 1.29, 95%CI 1.1-1.5, p = 0.0025), and low hospital resection volume (vs high, OR 1.61, 95%CI 1.4-1.8, p < 0.0001). Complications were a significant independent predictor of death (OR 7.76, 95%CI 6.7-8.8, p < 0.0001), prolonged hospital stay (OR 6.94, 95%CI 6.2-7.7, p < 0.0001), and discharge to another facility (OR 0.28, 95%CI 0.26-0.3, p < 0.0001).


CONCLUSIONS
Despite improvements in mortality, complication rates remain substantial and largely unchanged. They predict in-hospital mortality, prolonged hospital stay, and delayed return to home. The impact on healthcare costs and quality of life deserves further study.
Simons
Jessica P
JP
Department of Surgery, UMass Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, Suite S3-752, Worcester, MA 01655, USA.
Shah
Shimul A
SA
Ng
Sing Chau
SC
Whalen
Giles F
GF
Tseng
Jennifer F
JF
D016208:Databases, Factual; D004066:Digestive System Diseases / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality* / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology