title: Surgical management of chronic pancreatitis: current utilization in the United States.
abstract: BACKGROUND
  Surgical intervention is uncommon in chronic pancreatitis. Literature largely describes single institution or international experiences. This study describes US-based chronic pancreatitis surgical management.
  
  
  METHODS
  Retrospective analysis of chronic pancreatitis patients in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007-2011. Patients with malignancy or congenital abnormalities were excluded. Univariate analysis using the chi-square test. The number of readmissions, inpatient length of stay and cost using Wilcoxon's signed-rank test. Multivariate analysis of surgery by logistic regression.
  
  
  RESULTS
  Twenty-one thousand four hundred and forty-five patients with chronic pancreatitis. 10.8% (2 307) underwent surgery including 1652 cholecystectomies, 564 drainage procedures and 498 pancreatectomies. Procedures decreased from 12.1% to 8.3% over time (P < 0.001), but intervention within 3 months increased (7.2% to 8.4%; P = 0.017). 15.3% (3 278) had pancreatic cysts/pseudocysts and 43.4% (9 312) had diabetes. The median numbers of admissions were 2 [interquartile range (IQR) 1,5] and 3 (IQR 2,7) among non-surgical and surgical patients, respectively (P < 0.001). Predictors of surgery were fewer co-morbidities, private insurance, and either diabetes mellitus or pancreatic cyst/pseudocyst.
  
  
  CONCLUSIONS
  Chronic pancreatitis leads to numerous inpatient readmissions, but surgical intervention only occurs in a minority of cases. Complicated patients are more likely to undergo surgery. The complexities of chronic pancreatitis management warrant early multidisciplinary evaluation and ongoing consideration of surgical and non-surgical options.
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Bliss
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Yang
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Mariam F
authors.initials: MF
authors.lastname: Eskander
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Susanna W L
authors.initials: SW
authors.lastname: de Geus
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser
authors.affiliation: Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Freedman
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D004322:Drainage / Q000191:economics* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D005102:Health Expenditures / Q000639:trends*; D006801:Humans; D008297:Male; D010180:Pancreatectomy / Q000191:economics* / Q000379:methods; D050500:Pancreatitis, Chronic / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States