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The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

Latenstein, Anouk E.J. ; Mackay, Tara M. ; Beane, Joal D. ; Busch, Olivier R. ; van Dieren, Susan ; Gleeson, Elizabeth M. ; Koerkamp, Bas Groot ; van Santvoort, Hjalmar C. ; Wellner, Ulrich F. and Williamsson, Caroline LU , et al. (2021) In Surgery (United States) 170(2). p.563-570
Abstract

Background: Total pancreatectomy has high morbidity and mortality and differences among countries are currently unknown. This study compared the use and postoperative outcomes of total pancreatectomy among 4 Western countries. Methods: Patients who underwent one-stage total pancreatectomy were included from registries in the United States, Germany, the Netherlands, and Sweden (2014–2018). Use of total pancreatectomy was assessed by calculating the ratio total pancreatectomy to pancreatoduodenectomy. Primary outcomes were major morbidity (Clavien Dindo ≥3) and in-hospital mortality. Predictors for the primary outcomes were assessed in multivariable logistic regression analyses. Sensitivity analysis assessed the impact of volume... (More)

Background: Total pancreatectomy has high morbidity and mortality and differences among countries are currently unknown. This study compared the use and postoperative outcomes of total pancreatectomy among 4 Western countries. Methods: Patients who underwent one-stage total pancreatectomy were included from registries in the United States, Germany, the Netherlands, and Sweden (2014–2018). Use of total pancreatectomy was assessed by calculating the ratio total pancreatectomy to pancreatoduodenectomy. Primary outcomes were major morbidity (Clavien Dindo ≥3) and in-hospital mortality. Predictors for the primary outcomes were assessed in multivariable logistic regression analyses. Sensitivity analysis assessed the impact of volume (low-volume <40 or high-volume ≥40 pancreatoduodenectomies annually; data available for the Netherlands and Germany). Results: In total, 1,579 patients underwent one-stage total pancreatectomy. The relative use of total pancreatectomy to pancreatoduodenectomy varied up to fivefold (United States 0.03, Germany 0.15, the Netherlands 0.03, and Sweden 0.15; P <.001). Both the indication and several baseline characteristics differed significantly among countries. Major morbidity occurred in 423 patients (26.8%) and differed (22.3%, 34.9%, 38.3%, and 15.9%, respectively; P <.001). In-hospital mortality occurred in 85 patients (5.4%) and also differed (1.8%, 10.2%, 10.8%, 1.9%, respectively; P <.001). Country, age ≥75, and vascular resection were predictors for in-hospital mortality. In-hospital mortality was lower in high-volume centers in the Netherlands (4.9% vs 23.1%; P =.002), but not in Germany (9.8% vs 10.6%; P =.733). Conclusion: Considerable differences in the use of total pancreatectomy, patient characteristics, and postoperative outcome were noted among 4 Western countries with better outcomes in the United States and Sweden. These large, yet unexplained, differences require further research to ultimately improve patient outcome.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Surgery (United States)
volume
170
issue
2
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85102648221
  • pmid:33741182
ISSN
0039-6060
DOI
10.1016/j.surg.2021.02.001
language
English
LU publication?
yes
id
68f94873-f951-4176-b0e8-3050886ffd44
date added to LUP
2021-03-29 14:29:41
date last changed
2024-12-15 04:45:33
@article{68f94873-f951-4176-b0e8-3050886ffd44,
  abstract     = {{<p>Background: Total pancreatectomy has high morbidity and mortality and differences among countries are currently unknown. This study compared the use and postoperative outcomes of total pancreatectomy among 4 Western countries. Methods: Patients who underwent one-stage total pancreatectomy were included from registries in the United States, Germany, the Netherlands, and Sweden (2014–2018). Use of total pancreatectomy was assessed by calculating the ratio total pancreatectomy to pancreatoduodenectomy. Primary outcomes were major morbidity (Clavien Dindo ≥3) and in-hospital mortality. Predictors for the primary outcomes were assessed in multivariable logistic regression analyses. Sensitivity analysis assessed the impact of volume (low-volume &lt;40 or high-volume ≥40 pancreatoduodenectomies annually; data available for the Netherlands and Germany). Results: In total, 1,579 patients underwent one-stage total pancreatectomy. The relative use of total pancreatectomy to pancreatoduodenectomy varied up to fivefold (United States 0.03, Germany 0.15, the Netherlands 0.03, and Sweden 0.15; P &lt;.001). Both the indication and several baseline characteristics differed significantly among countries. Major morbidity occurred in 423 patients (26.8%) and differed (22.3%, 34.9%, 38.3%, and 15.9%, respectively; P &lt;.001). In-hospital mortality occurred in 85 patients (5.4%) and also differed (1.8%, 10.2%, 10.8%, 1.9%, respectively; P &lt;.001). Country, age ≥75, and vascular resection were predictors for in-hospital mortality. In-hospital mortality was lower in high-volume centers in the Netherlands (4.9% vs 23.1%; P =.002), but not in Germany (9.8% vs 10.6%; P =.733). Conclusion: Considerable differences in the use of total pancreatectomy, patient characteristics, and postoperative outcome were noted among 4 Western countries with better outcomes in the United States and Sweden. These large, yet unexplained, differences require further research to ultimately improve patient outcome.</p>}},
  author       = {{Latenstein, Anouk E.J. and Mackay, Tara M. and Beane, Joal D. and Busch, Olivier R. and van Dieren, Susan and Gleeson, Elizabeth M. and Koerkamp, Bas Groot and van Santvoort, Hjalmar C. and Wellner, Ulrich F. and Williamsson, Caroline and Tingstedt, Bobby and Keck, Tobias and Pitt, Henry A. and Besselink, Marc G.}},
  issn         = {{0039-6060}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{2}},
  pages        = {{563--570}},
  publisher    = {{Elsevier}},
  series       = {{Surgery (United States)}},
  title        = {{The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden}},
  url          = {{http://dx.doi.org/10.1016/j.surg.2021.02.001}},
  doi          = {{10.1016/j.surg.2021.02.001}},
  volume       = {{170}},
  year         = {{2021}},
}