title: Total pancreatectomy and islet autotransplantation: A decade nationwide analysis.
abstract: OBJECTIVE
  To investigate outcomes and predictors of in-hospital morbidity and mortality after total pancreatectomy (TP) and islet autotransplantation.
  
  
  METHODS
  The nationwide inpatient sample (NIS) database was used to identify patients who underwent TP and islet autotransplantation (IAT) between 2002-2012 in the United States. Variables of interest were inherent variables of NIS database which included demographic data (age, sex, and race), comorbidities (such as diabetes mellitus, hypertension, and deficiency anemia), and admission type (elective vs non-elective). The primary endpoints were mortality and postoperative complications according to the ICD-9 diagnosis codes which were reported as the second to 25(th) diagnosis of patients in the database. Risk adjusted analysis was performed to investigate morbidity predictors. Multivariate regression analysis was used to identify predictors of in-hospital morbidity.
  
  
  RESULTS
  We evaluated a total of 923 patients who underwent IAT after pancreatectomy during 2002-2012. Among them, there were 754 patients who had TP + IAT. The most common indication of surgery was chronic pancreatitis (86%) followed by acute pancreatitis (12%). The number of patients undergoing TP + IAT annually significantly increased during the 11 years of study from 53 cases in 2002 to 155 cases in 2012. Overall mortality and morbidity of patients were 0% and 57.8 %, respectively. Post-surgical hypoinsulinemia was reported in 42.3% of patients, indicating that 57.7% of patients were insulin independent during hospitalization. Predictors of in-hospital morbidity were obesity [adjusted odds ratio (AOR): 3.02, P = 0.01], fluid and electrolyte disorders (AOR: 2.71, P < 0.01), alcohol abuse (AOR: 2.63, P < 0.01), and weight loss (AOR: 2.43, P < 0.01).
  
  
  CONCLUSIONS
  TP + IAT is a safe procedure with no mortality, acceptable morbidity, and achieved high rate of early insulin independence. Obesity is the most significant predictor of in-hospital morbidity.
authors.affiliation: Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
authors.forename: Reza
authors.initials: R
authors.lastname: Fazlalizadeh
authors.affiliation: Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
authors.forename: Zhobin
authors.initials: Z
authors.lastname: Moghadamyeghaneh
authors.affiliation: Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
authors.forename: Aram N
authors.initials: AN
authors.lastname: Demirjian
authors.affiliation: Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
authors.forename: David K
authors.initials: DK
authors.lastname: Imagawa
authors.affiliation: Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
authors.forename: Clarence E
authors.initials: CE
authors.lastname: Foster
authors.affiliation: Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Lakey
authors.affiliation: Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.affiliation: Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Ichii
keywords: Chronic pancreatitis; Insulin independency; Islet auto transplantation; Pancreatectomy; Total pancreatectomy