title: Concomitant vascular reconstruction during pancreatectomy for malignant disease: a propensity score-adjusted, population-based trend analysis involving 10,206 patients.
abstract: OBJECTIVE
  To assess trends in the frequency of concomitant vascular reconstructions (VRs) from 2000 through 2009 among patients who underwent pancreatectomy, as well as to compare the short-term outcomes between patients who underwent pancreatic resection with and without VR.
  
  
  METHODS
  Single-center series have been conducted to evaluate the short-term and long-term outcomes of VR during pancreatic resection. However, its effectiveness from a population-based perspective is still unknown. Unadjusted, multivariable, and propensity score-adjusted generalized linear models were performed.
  
  
  METHODS
  Nationwide Inpatient Sample from 2000 through 2009.
  
  
  METHODS
  A total of 10,206 patients were involved.
  
  
  METHODS
  Incidence of VR during pancreatic resection, perioperative in-hospital complications, and length of hospital stay.
  
  
  RESULTS
  Overall, 10,206 patients were included in this analysis. Of these, 412 patients (4.0%) underwent VR, with the rate increasing from 0.7% in 2000 to 6.0% in 2009 (P < .001). Patients who underwent pancreatic resection with VR were at a higher risk for intraoperative (propensity score-adjusted odds ratio, 1.94; P = .001) and postoperative (propensity score-adjusted odds ratio, 1.36; P = .008) complications, while the mortality and median length of hospital stay were similar to those of patients without VR. Among the 25% of hospitals with the highest surgical volume, patients who underwent pancreatic surgery with VR had significantly higher rates of postoperative complications and mortality than patients without VR.
  
  
  CONCLUSIONS
  The frequency of VR during pancreatic surgery is increasing in the United States. In contrast with most single-center analyses, this population-based study demonstrated that patients who underwent VR during pancreatic surgery had higher rates of adverse postoperative outcomes than their counterparts who underwent pancreatic resection only. Prospective studies incorporating long-term outcomes are warranted to further define which patients benefit from VR.
authors.affiliation: Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Worni
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
authors.forename: Beat
authors.initials: B
authors.lastname: Gloor
authors.forename: Elias
authors.initials: E
authors.lastname: Carvalho
authors.forename: Danny O
authors.initials: DO
authors.lastname: Jacobs
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
authors.forename: Rebekah R
authors.initials: RR
authors.lastname: White
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D003953:Diagnosis-Related Groups; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply* / Q000601:surgery*; D010180:Pancreatectomy / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality