National trends in resection of the distal pancreas

Armando Rosales-Velderrain, Steven P. Bowers, Ross F. Goldberg, Tatyan M. Clarke, Mauricia A. Buchanan, John A. Stauffer, Horacio J. Asbun

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

AIM: To investigate national trends in distal pancreatectomy (DP) through query of three national patient care databases. METHODS: From the Nationwide Inpatient Sample (NIS, 2003-2009), the National Surgical Quality Improvement Project (NSQIP, 2005-2010), and the Surveillance Epidemiology and End Results (SEER, 2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy. Utilization of laparoscopy was defined in NIS by the International Classification of Diseases, Ninth Revision correspondent procedure code; and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes. In SEER, patients were identified by the International Classification of Diseases for Oncology, Third Edition diagnosis codes and the SEER Program Code Manual, third edition procedure codes. We analyzed the databases with respect to trends of inpatient outcome metrics, oncologic outcomes, and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection. RESULTS: NIS, NSQIP and SEER identified 4242, 2681 and 11 082 DP resections, respectively. Overall, laparoscopy was utilized in 15% (NIS) and 27% (NSQIP). No significant increase was seen over the course of the study. Resection was performed for malignancy in 59% (NIS) and 66% (NSQIP). Neither patient Body mass index nor comorbidities were associated with operative approach (P = 0.95 and P = 0.96, respectively). Mortality (3% vs 2%, P = 0.05) and reoperation (4% vs 4%, P = 1.0) was not different between laparoscopy and open groups. Overall complications (10% vs 15%, P < 0.001), hospital costs [44 741 dollars, interquartile range (IQR) 28 347-74 114 dollars vs 49 792 dollars, IQR 13 299-73 463, P = 0.02] and hospital length of stay (7 d, IQR 4-11 d vs 7 d, IQR 6-10, P < 0.001) were less when laparoscopy was utilized. One and two year survival after resection for malignancy were unchanged over the course of the study (ductal adenocarinoma 1-year 63.6% and 2-year 35.1%, P = 0.53; intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%, P = 0.25). The majority of resections were performed in teaching hospitals (77% NIS and 85% NSQIP), but minimally invasive surgery (MIS) was not more likely to be used in teaching hospitals (15% vs 14%, P = 0.26). Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles (88% vs 43%, P < 0.001), but were no more likely to utilize MIS at resection. Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching (15% vs 14%, P = 0.72) and lower volume hospitals (14% vs 15%, P = 0.99). No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year (P = 0.17 and P = 0.96, respectively). CONCLUSION: There appears to be an overall underutilization of laparoscopy for DP. Centralization does not appear to be occurring. Survival and lymph node harvest have not changed.

Original languageEnglish (US)
Pages (from-to)4342-4349
Number of pages8
JournalWorld Journal of Gastroenterology
Volume18
Issue number32
DOIs
StatePublished - 2012

Fingerprint

Laparoscopy
Pancreas
Pancreatectomy
Teaching Hospitals
Minimally Invasive Surgical Procedures
Lymph Nodes
International Classification of Diseases
Databases
Inpatients
Length of Stay
Current Procedural Terminology
SEER Program
Neoplasms
Hospital Costs
Quality Improvement
Reoperation
Comorbidity
Patient Care
Teaching
Epidemiology

Keywords

  • Laparoscopic distal pancreatectomy
  • National Surgical Quality Improvement Project
  • Nationwide Inpatient Sample
  • Surveillance epidemiology and end results
  • Trends

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rosales-Velderrain, A., Bowers, S. P., Goldberg, R. F., Clarke, T. M., Buchanan, M. A., Stauffer, J. A., & Asbun, H. J. (2012). National trends in resection of the distal pancreas. World Journal of Gastroenterology, 18(32), 4342-4349. https://doi.org/10.3748/wjg.v18.i32.4342

National trends in resection of the distal pancreas. / Rosales-Velderrain, Armando; Bowers, Steven P.; Goldberg, Ross F.; Clarke, Tatyan M.; Buchanan, Mauricia A.; Stauffer, John A.; Asbun, Horacio J.

In: World Journal of Gastroenterology, Vol. 18, No. 32, 2012, p. 4342-4349.

Research output: Contribution to journalArticle

Rosales-Velderrain, A, Bowers, SP, Goldberg, RF, Clarke, TM, Buchanan, MA, Stauffer, JA & Asbun, HJ 2012, 'National trends in resection of the distal pancreas', World Journal of Gastroenterology, vol. 18, no. 32, pp. 4342-4349. https://doi.org/10.3748/wjg.v18.i32.4342
Rosales-Velderrain A, Bowers SP, Goldberg RF, Clarke TM, Buchanan MA, Stauffer JA et al. National trends in resection of the distal pancreas. World Journal of Gastroenterology. 2012;18(32):4342-4349. https://doi.org/10.3748/wjg.v18.i32.4342
Rosales-Velderrain, Armando ; Bowers, Steven P. ; Goldberg, Ross F. ; Clarke, Tatyan M. ; Buchanan, Mauricia A. ; Stauffer, John A. ; Asbun, Horacio J. / National trends in resection of the distal pancreas. In: World Journal of Gastroenterology. 2012 ; Vol. 18, No. 32. pp. 4342-4349.
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abstract = "AIM: To investigate national trends in distal pancreatectomy (DP) through query of three national patient care databases. METHODS: From the Nationwide Inpatient Sample (NIS, 2003-2009), the National Surgical Quality Improvement Project (NSQIP, 2005-2010), and the Surveillance Epidemiology and End Results (SEER, 2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy. Utilization of laparoscopy was defined in NIS by the International Classification of Diseases, Ninth Revision correspondent procedure code; and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes. In SEER, patients were identified by the International Classification of Diseases for Oncology, Third Edition diagnosis codes and the SEER Program Code Manual, third edition procedure codes. We analyzed the databases with respect to trends of inpatient outcome metrics, oncologic outcomes, and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection. RESULTS: NIS, NSQIP and SEER identified 4242, 2681 and 11 082 DP resections, respectively. Overall, laparoscopy was utilized in 15{\%} (NIS) and 27{\%} (NSQIP). No significant increase was seen over the course of the study. Resection was performed for malignancy in 59{\%} (NIS) and 66{\%} (NSQIP). Neither patient Body mass index nor comorbidities were associated with operative approach (P = 0.95 and P = 0.96, respectively). Mortality (3{\%} vs 2{\%}, P = 0.05) and reoperation (4{\%} vs 4{\%}, P = 1.0) was not different between laparoscopy and open groups. Overall complications (10{\%} vs 15{\%}, P < 0.001), hospital costs [44 741 dollars, interquartile range (IQR) 28 347-74 114 dollars vs 49 792 dollars, IQR 13 299-73 463, P = 0.02] and hospital length of stay (7 d, IQR 4-11 d vs 7 d, IQR 6-10, P < 0.001) were less when laparoscopy was utilized. One and two year survival after resection for malignancy were unchanged over the course of the study (ductal adenocarinoma 1-year 63.6{\%} and 2-year 35.1{\%}, P = 0.53; intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90{\%} and 2-year 84{\%}, P = 0.25). The majority of resections were performed in teaching hospitals (77{\%} NIS and 85{\%} NSQIP), but minimally invasive surgery (MIS) was not more likely to be used in teaching hospitals (15{\%} vs 14{\%}, P = 0.26). Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles (88{\%} vs 43{\%}, P < 0.001), but were no more likely to utilize MIS at resection. Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching (15{\%} vs 14{\%}, P = 0.72) and lower volume hospitals (14{\%} vs 15{\%}, P = 0.99). No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year (P = 0.17 and P = 0.96, respectively). CONCLUSION: There appears to be an overall underutilization of laparoscopy for DP. Centralization does not appear to be occurring. Survival and lymph node harvest have not changed.",
keywords = "Laparoscopic distal pancreatectomy, National Surgical Quality Improvement Project, Nationwide Inpatient Sample, Surveillance epidemiology and end results, Trends",
author = "Armando Rosales-Velderrain and Bowers, {Steven P.} and Goldberg, {Ross F.} and Clarke, {Tatyan M.} and Buchanan, {Mauricia A.} and Stauffer, {John A.} and Asbun, {Horacio J.}",
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TY - JOUR

T1 - National trends in resection of the distal pancreas

AU - Rosales-Velderrain, Armando

AU - Bowers, Steven P.

AU - Goldberg, Ross F.

AU - Clarke, Tatyan M.

AU - Buchanan, Mauricia A.

AU - Stauffer, John A.

AU - Asbun, Horacio J.

PY - 2012

Y1 - 2012

N2 - AIM: To investigate national trends in distal pancreatectomy (DP) through query of three national patient care databases. METHODS: From the Nationwide Inpatient Sample (NIS, 2003-2009), the National Surgical Quality Improvement Project (NSQIP, 2005-2010), and the Surveillance Epidemiology and End Results (SEER, 2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy. Utilization of laparoscopy was defined in NIS by the International Classification of Diseases, Ninth Revision correspondent procedure code; and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes. In SEER, patients were identified by the International Classification of Diseases for Oncology, Third Edition diagnosis codes and the SEER Program Code Manual, third edition procedure codes. We analyzed the databases with respect to trends of inpatient outcome metrics, oncologic outcomes, and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection. RESULTS: NIS, NSQIP and SEER identified 4242, 2681 and 11 082 DP resections, respectively. Overall, laparoscopy was utilized in 15% (NIS) and 27% (NSQIP). No significant increase was seen over the course of the study. Resection was performed for malignancy in 59% (NIS) and 66% (NSQIP). Neither patient Body mass index nor comorbidities were associated with operative approach (P = 0.95 and P = 0.96, respectively). Mortality (3% vs 2%, P = 0.05) and reoperation (4% vs 4%, P = 1.0) was not different between laparoscopy and open groups. Overall complications (10% vs 15%, P < 0.001), hospital costs [44 741 dollars, interquartile range (IQR) 28 347-74 114 dollars vs 49 792 dollars, IQR 13 299-73 463, P = 0.02] and hospital length of stay (7 d, IQR 4-11 d vs 7 d, IQR 6-10, P < 0.001) were less when laparoscopy was utilized. One and two year survival after resection for malignancy were unchanged over the course of the study (ductal adenocarinoma 1-year 63.6% and 2-year 35.1%, P = 0.53; intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%, P = 0.25). The majority of resections were performed in teaching hospitals (77% NIS and 85% NSQIP), but minimally invasive surgery (MIS) was not more likely to be used in teaching hospitals (15% vs 14%, P = 0.26). Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles (88% vs 43%, P < 0.001), but were no more likely to utilize MIS at resection. Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching (15% vs 14%, P = 0.72) and lower volume hospitals (14% vs 15%, P = 0.99). No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year (P = 0.17 and P = 0.96, respectively). CONCLUSION: There appears to be an overall underutilization of laparoscopy for DP. Centralization does not appear to be occurring. Survival and lymph node harvest have not changed.

AB - AIM: To investigate national trends in distal pancreatectomy (DP) through query of three national patient care databases. METHODS: From the Nationwide Inpatient Sample (NIS, 2003-2009), the National Surgical Quality Improvement Project (NSQIP, 2005-2010), and the Surveillance Epidemiology and End Results (SEER, 2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy. Utilization of laparoscopy was defined in NIS by the International Classification of Diseases, Ninth Revision correspondent procedure code; and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes. In SEER, patients were identified by the International Classification of Diseases for Oncology, Third Edition diagnosis codes and the SEER Program Code Manual, third edition procedure codes. We analyzed the databases with respect to trends of inpatient outcome metrics, oncologic outcomes, and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection. RESULTS: NIS, NSQIP and SEER identified 4242, 2681 and 11 082 DP resections, respectively. Overall, laparoscopy was utilized in 15% (NIS) and 27% (NSQIP). No significant increase was seen over the course of the study. Resection was performed for malignancy in 59% (NIS) and 66% (NSQIP). Neither patient Body mass index nor comorbidities were associated with operative approach (P = 0.95 and P = 0.96, respectively). Mortality (3% vs 2%, P = 0.05) and reoperation (4% vs 4%, P = 1.0) was not different between laparoscopy and open groups. Overall complications (10% vs 15%, P < 0.001), hospital costs [44 741 dollars, interquartile range (IQR) 28 347-74 114 dollars vs 49 792 dollars, IQR 13 299-73 463, P = 0.02] and hospital length of stay (7 d, IQR 4-11 d vs 7 d, IQR 6-10, P < 0.001) were less when laparoscopy was utilized. One and two year survival after resection for malignancy were unchanged over the course of the study (ductal adenocarinoma 1-year 63.6% and 2-year 35.1%, P = 0.53; intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%, P = 0.25). The majority of resections were performed in teaching hospitals (77% NIS and 85% NSQIP), but minimally invasive surgery (MIS) was not more likely to be used in teaching hospitals (15% vs 14%, P = 0.26). Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles (88% vs 43%, P < 0.001), but were no more likely to utilize MIS at resection. Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching (15% vs 14%, P = 0.72) and lower volume hospitals (14% vs 15%, P = 0.99). No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year (P = 0.17 and P = 0.96, respectively). CONCLUSION: There appears to be an overall underutilization of laparoscopy for DP. Centralization does not appear to be occurring. Survival and lymph node harvest have not changed.

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KW - National Surgical Quality Improvement Project

KW - Nationwide Inpatient Sample

KW - Surveillance epidemiology and end results

KW - Trends

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