title: Early surgical bypass versus endoscopic stent placement in pancreatic cancer.
abstract: The optimal treatment for biliary obstruction in pancreatic cancer remains controversial between surgical bypass and endoscopic stenting.
  
  
  
  Retrospective analysis of unresected pancreatic cancer patients in the Healthcare Cost and Utilization Project Florida State Inpatient and Ambulatory Surgery databases (2007-2011). Propensity score matching by procedure. Primary outcome was reintervention, and secondary outcomes were readmission, overall length of stay (LOS), discharge home, death and cost. Multivariate analyses performed by logistic regression.
  
  
  
  In a matched cohort of 622, 20.3% (63) of endoscopic and 4.5% (14) of surgical patients underwent reintervention (p < 0.0001) and 56.0% (174) vs. 60.1% (187) were readmitted (p = 0.2909). Endoscopic patients had lower median LOS (10 vs. 19 days, p < 0.0001) and cost ($21,648 vs. $38,106, p < 0.0001) as well as increased discharge home (p = 0.0029). No difference in mortality on index admission. On multivariate analysis, initial procedure not predictive of readmission (p = 0.1406), but early surgical bypass associated with lower odds of reintervention (OR = 0.233, 95% CI 0.119, 0.434).
  
  
  
  Among propensity score-matched patients receiving bypass vs. stenting, readmission and mortality rates are similar. However, candidates for both techniques may experience fewer subsequent procedures if offered early biliary bypass with the caveats of decreased discharge home and increased cost/LOS.
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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, United States.
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, United States.
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, United States.
authors.forename: Ammara A
authors.initials: AA
authors.lastname: Watkins
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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, United States.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Storino
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
authors.forename: Sing Chau
authors.initials: SC
authors.lastname: Ng
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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, United States.
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: jftseng@bidmc.harvard.edu.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
mesh_terms: D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016208:Databases, Factual; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005431:Florida; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality; D010351:Patient Discharge; D010359:Patient Readmission; D057216:Propensity Score; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome