title: Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief.
abstract: OBJECTIVE
  To evaluate the effect of timing of surgery on the long-term clinical outcome of surgery in chronic pancreatitis (CP).
  
  
  METHODS
  Cohort study with long-term follow-up.
  
  
  METHODS
  Five specialized academic centers.
  
  
  METHODS
  Patients with CP treated surgically for pain.
  
  
  METHODS
  Pancreatic resection and drainage procedures for pain relief.
  
  
  METHODS
  Pain relief (pain visual analogue score ≤4), pancreatic function, and quality of life.
  
  
  RESULTS
  We included 266 patients with median follow-up of 62 months (interquartile range, 31-112). Results were presented as odds ratios (ORs)with 95% confidence intervals after correction for bias using bootstrap-corrected analysis. Pain relief was achieved in 149 patients (58%). Surgery within 3 years of symptoms was independently associated with more pain relief (OR, 1.8; 95% CI, 1.0-3.4; P = .03) and less endocrine pancreatic insufficiency (OR, 0.57; 95% CI, 0.33-0.96; P = .04). More pain relief was also observed in patients not taking opioids preoperatively (OR, 2.1; 95% CI, 1.2-4.0; P = .006) and who had 5 or fewer endoscopic treatments prior to surgery (OR, 2.5; 95% CI, 1.1-6.3; P = .04). The probability of achieving pain relief varied between 23% and 75%, depending on these risk factors.
  
  
  CONCLUSIONS
  The timing of surgery is an important risk factor for clinical outcome in CP. Surgery may need to be considered at an earlier phase than it is now, preferably within 3 years of symptomatic CP. Likelihood of postoperative pain relief can be calculated on an individual basis using the presented nomogram.
authors.affiliation: Department of Surgery, University Medical Center, Utrecht. u.ahmedali@pancreatitis.nl
authors.forename: Usama
authors.initials: U
authors.lastname: Ahmed Ali
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Nieuwenhuijs
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Ronald M
authors.initials: RM
authors.lastname: van Dam
authors.forename: Olivier R
authors.initials: OR
authors.lastname: Busch
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: Femke A
authors.initials: FA
authors.lastname: Mauritz
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Jens
authors.forename: Jay
authors.initials: J
authors.lastname: Mast
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult