title: National trends in resection of cystic lesions of the pancreas.
abstract: BACKGROUND
  Management of cystic lesions of the pancreas (CLP) is controversial. In this study, we sought to evaluate national changes in the resection of CLP over time, to better understand the impact of evolving guidelines on CLP management.
  
  
  METHODS
  We used Medicare data to examine CLP resection among patients undergoing pancreatic resection between 2001 and 2012. Patients with a diagnosis of CLP were identified and compared to patients with non-CLP indications. We then examined changes over time in patient and hospital characteristics and outcomes among patients with a CLP diagnosis.
  
  
  RESULTS
  We identified 56,419 Medicare patients undergoing pancreatic resection, of which 2129 had a CLP diagnosis. The annual number of CLP resections, and proportion of all resections performed for CLP increased significantly during the period, from 2.1% (65/3072) resections in 2001, to 4.5% (286/6348) in 2012 (p < 0.001). The proportion of CLP resections with a malignant diagnosis did not change (15.5% in 2001-2003 vs. 13.1% in 2010-2012, p = 0.4). Overall rates of 30-day mortality decreased significantly during the period (9.6% in 2001-2003 vs. 5.5% in 2010-2012, p < 0.001).
  
  
  CONCLUSIONS
  CLP resections were performed with increasing frequency in Medicare patients between 2001 and 2012, but this did not correspond to increased diagnosis of malignancy. Additional research is needed to understand the influence of recent guidelines on management of CLP.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Reames
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Scally
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Frankel
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: drnathan@umich.edu.
authors.forename: Hari
authors.initials: H
authors.lastname: Nathan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000639:trends; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality / Q000592:standards / Q000639:trends*; D010181:Pancreatic Cyst / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality / Q000592:standards / Q000639:trends*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States