PancreasComparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy
Section snippets
Patient population and data collection
This study was approved by the Institutional Review Board at the University of Pennsylvania. Records for consecutive patients who received PD or DP for all indications between 2001 and 2014 were reviewed from prospectively collected databases at 4 high-volume pancreatic surgical practices. Postoperative complications were recorded by clinical research associates and complication grading was assigned by, or under the supervision of, attending surgeons familiar with complication severity scoring.8
PD versus DP: Demographic, operative, and pathologic characteristics
Fourteen surgeons performed 2,370 pancreatic resections, of which 1,533 (64.7%) were PD and 837 (35.3%) DP. Numerous differences existed between the PD and DP cohorts in terms of demographic and operative characteristics. Patients undergoing DP were more likely female (59.4 vs 50.6%; P < .0001) and obese (33.5 vs 22.5%; P < .0001), whereas PD patients were significantly older (median, 64 [IQR 56–72] vs 60 [IQR 49–69] years; P < .0001). A greater proportion of PD patients had pancreatic ductal
Discussion
This study demonstrates that, although the overall incidence of ISGPF POPFs is higher after DP compared with PD, the ACB of POPFs is typically greater after PD. Furthermore, POPFs are more likely the highest graded complication after DP, and they contribute to a greater proportion of overall complication burden after this procedure (31.4 vs 17.5%). Applying the concept of burden to the outcomes of health care providers revealed that ACB varied between institutions and surgeons for both PD and
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Funding: None.