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Distal Pancreatectomy Without Splenectomy Is Associated With Higher Reoperation Rates: Results of the Nationwide Inpatient Sample Database
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Distal Pancreatectomy Without Splenectomy Is Associated With Higher Reoperation Rates: Results of the Nationwide Inpatient Sample Database

Hassan Aziz, Evan Ong and Tun Jie
Journal of the American College of Surgeons, Vol.221(4), pp.S91-S91
10/2015
DOI: 10.1016/j.jamcollsurg.2015.07.208
url
https://doi.org/10.1016/j.jamcollsurg.2015.07.208View
Published (Version of record) Open Access

Abstract

Introduction Distal pancreatectomy with splenectomy has been considered the standard technique for management of benign and malignant pancreatic disorders. However, several studies have advocated splenic preservation in patients undergoing distal pancreatectomy to reduce the morbidity associated with the procedure. The aim of this study was to assess for differences in outcomes between these 2 procedures using a national database. Methods This retrospective cohort study used the 2009 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality. Patients who underwent distal pancreatectomy were grouped on the basis of whether they had splenectomy. The primary outcomes measure was difference in clinical outcomes between the 2 groups. Secondary outcome was hospital cost. Results Overall, 1,135 cases of distal pancreatectomy (distal pancreatectomy with splenectomy = 923; distal pancreatectomy without splenectomy = 212) were identified. The 2 groups were similar in in-hospital complications and mortality, with no associated cost differences ($44, 741, [interquartile range (IQR) $28,347-$74,114] vs $45,792, [IQR $13,299-$73,463], p = 0.1). Patients with distal pancreatectomy without splenectomy were, however, more likely to undergo a reoperation (23% vs 5%; 0.001). The cost for each reoperation was calculated as $7,780 ± $3,340. Conclusions In this analysis, splenectomy had no significant measurable impact on postoperative recovery, mortality, and cost. Patients with spleen-preserving distal pancreatectomy were more likely to undergo a reoperation, resulting in significantly higher financial implications.

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