title: Surgery for chronic pancreatitis: the role of early surgery in pain management.
abstract: OBJECTIVE
  To examine if surgery performed for pain of chronic pancreatitis (CP) within 3 years diagnosis has greater odds of achieving complete pain relief than later surgery and to find optimal surgical timing for attaining pain relief in CP.
  
  
  METHODS
  Retrospective review of records at a tertiary institution 2003 to 2011 for CP where the operative indication was pain. Outcomes were pain-free status, opioid use, and pancreatic insufficiency at 3-year follow-up. Univariate analysis by Fisher exact tests. Receiver operating curve to calculate cutoff threshold time for surgery.
  
  
  RESULTS
  Outcomes for 66 patients were included. Median preoperative CP duration was 28 months (interquartile range, 12, 67). Twenty-six patients (39.4%) were free of pain at the 3-year follow-up. Thirty-four patients (51.5%) were opioid users at follow-up. Postoperatively, 34 patients (51.5%) demonstrated endocrine, and 32 patients (48.5%) demonstrated exocrine insufficiency. The optimal cutoff point for preoperative CP duration was 26.5 months (area under the curve, 0.66). Shorter duration of CP before surgery was a predictor of pain-free status and reduced postoperative opioid use at follow-up.
  
  
  CONCLUSIONS
  Results from a single institution analysis suggest early surgical intervention of 26.5 months or less of diagnosis is associated with improved pain control, and optimal timing for surgery may be earlier than previously thought.
authors.affiliation: From the *Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center and Harvard Medical School; †Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA; and ‡Department of Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Yang
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Bliss
authors.forename: Steven D
authors.initials: SD
authors.lastname: Freedman
authors.forename: Sunil
authors.initials: S
authors.lastname: Sheth
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
authors.forename: Sing Chau
authors.initials: SC
authors.lastname: Ng
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001900:Boston; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010180:Pancreatectomy / Q000009:adverse effects; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid