National complication rates after pancreatectomy: beyond mere mortality
UMass Chan Affiliations
Department of SurgeryDocument Type
Journal ArticlePublication Date
2009-10-10Keywords
Databases, FactualDigestive System Diseases
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Pancreatectomy
Patient Discharge
Postoperative Complications
Risk Factors
Time Factors
United States
Surgery
Metadata
Show full item recordAbstract
INTRODUCTION: National studies on in-hospital pancreatic outcomes have focused on mortality. Non-fatal morbidity affects a greater proportion of patients. METHODS: The Nationwide Inpatient Sample 1998-2006 was queried for discharges after pancreatectomy. Rates of major complications (myocardial infarction, aspiration pneumonia, pulmonary compromise, perforation, infection, deep vein thrombosis/pulmonary embolism, hemorrhage, or reopening of laparotomy) were assessed. Predictors of complication(s) were evaluated using logistic regression. Their independent effect on in-hospital mortality, length of stay, and discharge disposition was assessed. RESULTS: Of 102,417 patient discharges, 22.7% experienced a complication. Complication rates did not decline significantly over time, while mortality rates did. Independent predictors of complications included age >or=75 [referent, 19-39; adjusted odds ratio (OR) 1.34, 95% confidence interval (CI) 1.2-1.5, p < 0.0001], total pancreatectomy (vs proximal, OR 1.29, 95%CI 1.1-1.5, p = 0.0025), and low hospital resection volume (vs high, OR 1.61, 95%CI 1.4-1.8, p < 0.0001). Complications were a significant independent predictor of death (OR 7.76, 95%CI 6.7-8.8, p < 0.0001), prolonged hospital stay (OR 6.94, 95%CI 6.2-7.7, p < 0.0001), and discharge to another facility (OR 0.28, 95%CI 0.26-0.3, p < 0.0001). CONCLUSIONS: Despite improvements in mortality, complication rates remain substantial and largely unchanged. They predict in-hospital mortality, prolonged hospital stay, and delayed return to home. The impact on healthcare costs and quality of life deserves further study.Source
J Gastrointest Surg. 2009 Oct;13(10):1798-805. Epub 2009 Jun 9. Link to article on publisher's siteDOI
10.1007/s11605-009-0936-1Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49787PubMed ID
19506975Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1007/s11605-009-0936-1