Concomitant vascular reconstruction during pancreatectomy for malignant disease

A propensity score-adjusted, population-based trend analysis involving 10 206 patients

Mathias Worni, Anthony W. Castleberry, Bryan M. Clary, Beat Gloor, Elias Carvalho, Danny O. Jacobs, Ricardo Pietrobon, John E. Scarborough, Rebekah R. White

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: To assess trends in the frequency of concomitant vascular reconstructions (VRs) from 2000 through 2009 among patients who underwent pancreatectomy, as well as to compare the short-term outcomes between patients who underwent pancreatic resection with and without VR. Design: Single-center series have been conducted to evaluate the short-term and long-term outcomes of VR during pancreatic resection. However, its effectiveness from a population-based perspective is still unknown. Unadjusted, multivariable, and propensity score-adjusted generalized linear models were performed. Setting: Nationwide Inpatient Sample from 2000 through 2009. Patients: A total of 10 206 patients were involved. Main Outcome Measures: Incidence of VR during pancreatic resection, perioperative in-hospital complications, and length of hospital stay. Results: Overall, 10 206 patients were included in this analysis. Of these, 412 patients (4.0%) underwent VR, with the rate increasing from 0.7% in 2000 to 6.0% in 2009 (P>.001). Patients who underwent pancreatic resection with VR were at a higher risk for intraoperative (propensity score-adjusted odds ratio, 1.94; P=.001) and postoperative (propensity score-adjusted odds ratio, 1.36; P=.008) complications, while the mortality and median length of hospital stay were similar to those of patients without VR. Among the 25% of hospitals with the highest surgical volume, patients who underwent pancreatic surgery with VR had significantly higher rates of postoperative complications and mortality than patients without VR. Conclusions: The frequency of VR during pancreatic surgery is increasing in the United States. In contrast with most single-center analyses, this population-based study demonstrated that patients who underwent VR during pancreatic surgery had higher rates of adverse postoperative outcomes than their counterparts who underwent pancreatic resection only. Prospective studies incorporating long-term outcomes are warranted to further define which patients benefit from VR.

Original languageEnglish (US)
Pages (from-to)331-338
Number of pages8
JournalJAMA Surgery
Volume148
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

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Propensity Score
Pancreatectomy
Blood Vessels
Population
Length of Stay
Odds Ratio
Mortality
Inpatients
Linear Models

ASJC Scopus subject areas

  • Surgery

Cite this

Concomitant vascular reconstruction during pancreatectomy for malignant disease : A propensity score-adjusted, population-based trend analysis involving 10 206 patients. / Worni, Mathias; Castleberry, Anthony W.; Clary, Bryan M.; Gloor, Beat; Carvalho, Elias; Jacobs, Danny O.; Pietrobon, Ricardo; Scarborough, John E.; White, Rebekah R.

In: JAMA Surgery, Vol. 148, No. 4, 04.2013, p. 331-338.

Research output: Contribution to journalArticle

Worni, M, Castleberry, AW, Clary, BM, Gloor, B, Carvalho, E, Jacobs, DO, Pietrobon, R, Scarborough, JE & White, RR 2013, 'Concomitant vascular reconstruction during pancreatectomy for malignant disease: A propensity score-adjusted, population-based trend analysis involving 10 206 patients', JAMA Surgery, vol. 148, no. 4, pp. 331-338. https://doi.org/10.1001/jamasurg.2013.1058
Worni, Mathias ; Castleberry, Anthony W. ; Clary, Bryan M. ; Gloor, Beat ; Carvalho, Elias ; Jacobs, Danny O. ; Pietrobon, Ricardo ; Scarborough, John E. ; White, Rebekah R. / Concomitant vascular reconstruction during pancreatectomy for malignant disease : A propensity score-adjusted, population-based trend analysis involving 10 206 patients. In: JAMA Surgery. 2013 ; Vol. 148, No. 4. pp. 331-338.
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abstract = "Objective: To assess trends in the frequency of concomitant vascular reconstructions (VRs) from 2000 through 2009 among patients who underwent pancreatectomy, as well as to compare the short-term outcomes between patients who underwent pancreatic resection with and without VR. Design: Single-center series have been conducted to evaluate the short-term and long-term outcomes of VR during pancreatic resection. However, its effectiveness from a population-based perspective is still unknown. Unadjusted, multivariable, and propensity score-adjusted generalized linear models were performed. Setting: Nationwide Inpatient Sample from 2000 through 2009. Patients: A total of 10 206 patients were involved. Main Outcome Measures: Incidence of VR during pancreatic resection, perioperative in-hospital complications, and length of hospital stay. Results: Overall, 10 206 patients were included in this analysis. Of these, 412 patients (4.0{\%}) underwent VR, with the rate increasing from 0.7{\%} in 2000 to 6.0{\%} in 2009 (P>.001). Patients who underwent pancreatic resection with VR were at a higher risk for intraoperative (propensity score-adjusted odds ratio, 1.94; P=.001) and postoperative (propensity score-adjusted odds ratio, 1.36; P=.008) complications, while the mortality and median length of hospital stay were similar to those of patients without VR. Among the 25{\%} of hospitals with the highest surgical volume, patients who underwent pancreatic surgery with VR had significantly higher rates of postoperative complications and mortality than patients without VR. Conclusions: The frequency of VR during pancreatic surgery is increasing in the United States. In contrast with most single-center analyses, this population-based study demonstrated that patients who underwent VR during pancreatic surgery had higher rates of adverse postoperative outcomes than their counterparts who underwent pancreatic resection only. Prospective studies incorporating long-term outcomes are warranted to further define which patients benefit from VR.",
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