title: Complications after pancreatectomy for neuroendocrine tumors: a national study.
abstract: BACKGROUND
  Although resection of pancreatic neuroendocrine tumors (PNETs) has a demonstrated survival advantage, further evaluation of the overall morbidity of these procedures is needed. Our objective was to examine a composite outcome of major postoperative complications, including in-hospital mortality.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS), 1998-2006, was used to identify all patients with a diagnosis of PNET who had undergone pancreatectomy. Candidate predictors consisted of patient and hospital characteristics. Univariate analyses included chi(2) tests. Multivariate analyses were performed with logistic regression to determine which predictors were independently associated with the composite outcome.
  
  
  RESULTS
  A total of 463 (2274 nationally weighted) patients were identified. Overall composite postoperative complication rate was 29.6%. The majority of complications involved infections (11.1%), digestive complications (8.8%), or pulmonary compromise (7.3%). In-hospital mortality rate was 1.7%. High Charlson comorbidity score, procedure type of Whipple or total pancreatectomy, and urban hospital location were all associated with significantly increased complication rate. Logistic regression analysis demonstrated: Charlson score of > or =3 versus score of 0 (adjusted odds ratio (OR) 4.1, 95% confidence interval (CI) 2.1-8.3), surgery type of Whipple or total pancreatectomy versus partial pancreatectomy (adjusted OR 2.7, 95% CI 1.8-4.1), and hospital location of urban versus rural (adjusted OR 4.5, 95% CI 3.0-6.9).
  
  
  CONCLUSIONS
  While in-hospital mortality rates are low for surgical resection of PNETs, there is a considerable overall postoperative complication rate associated with these procedures. Careful patient and surgery selection may be the key to a surgical treatment approach for PNETs that may optimize outcomes.
authors.affiliation: Surgical Outcomes Analysis and Research (SOAR), University of Massachusetts Medical School, Worcester, Massachusetts 01655-0002, USA.
authors.forename: Jillian K
authors.initials: JK
authors.lastname: Smith
authors.forename: Sing Chau
authors.initials: SC
authors.lastname: Ng
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Hill
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Simons
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Arous
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
authors.forename: Theodore P
authors.initials: TP
authors.lastname: McDade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017599:Neuroectodermal Tumors / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult