title: Determinants of outcomes in pancreatic surgery and use of hospital resources.
abstract: OBJECTIVE
  Outcomes for patients undergoing major pancreatic surgery have improved, but a subset of patients that significantly utilize more resources exists. Variables that can lead to an increase in resource utilization in patients undergoing pancreatic surgery were identified.
  
  
  METHODS
  Patients undergoing pancreatic surgery for neoplasms were identified from the NSQIP database (2006-2008). Indices associated with increased resource utilization that we included were operative time (OT), length of stay (LOS), intraoperative RBC transfusion, return to operating room, and occurrence of postoperative complications. Analysis of covariance and multivariable logistic regression were performed.
  
  
  RESULTS
  The 4,306 included patients had a median age of 66 years and 50.3% were males. The 30-day morbidity and mortality were 29.3% and 3.2%, respectively. Median OT was 362  min and median LOS was 10 days. Malignancy, neoadjuvant radiation, and medical co-morbidities were associated with increased OT (P < 0.0001 for all). Declining preoperative functional status was the most important predictor of LOS (P < 0.0001). Age, male gender, hypertension, severe COPD, and higher BMI were significantly associated with postoperative complications (P < 0.050 for all).
  
  
  CONCLUSIONS
  Morbidity after pancreatic surgery remains high. Age, obesity, performance status, medical co-morbidities, and neoadjuvant radiation affect outcomes and may lead to increased use of hospital resources.
authors.affiliation: Department of Surgery, Creighton University, Omaha, Nebraska, USA.
authors.forename: Prateek K
authors.initials: PK
authors.lastname: Gupta
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: Weldon J
authors.initials: WJ
authors.lastname: Miller
authors.forename: Brian W
authors.initials: BW
authors.lastname: Loggie
authors.forename: Jason M
authors.initials: JM
authors.lastname: Foster
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome