Predictors of Early Discharge After Pancreaticoduodenectomy in Patients With Adenocarcinoma
Jose E. Gonzalez, Mateo E. Garland, Christopher J. Polanco-Santana, Manuel Castillo-Angeles, Tara S. Kent
Surgery, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, United States
Objective: Pancreaticoduodenectomy (PD) remains one of the most challenging surgical procedures, with high morbidity rates, prolonged hospital length of stay (LOS), and high resource utilization. Multiple efforts have been directed toward identifying factors that help improve overall patient outcomes, eliminate redundant or excess resource utilization, and shorten LOS. The objective of this study was to identify predictors of early discharge in patients with pancreatic adenocarcinoma after PD to inform expectations of patients and providers.
Design: A retrospective cohort study.
Patients or other participants: The ACS-NSQIP pancreas-targeted database was queried to identify patients with pancreatic adenocarcinoma who underwent PD from 2014-20.
Main outcome measures: Patients with postoperative length of stay (LOS) ≤ 5 days were classified as early discharge based on the distribution of LOS in previous studies. Multivariate logistic regression was used to identify predictors of early discharge. Subgroup analysis was performed to determine if predictors differ between open and minimally invasive (MIS) approaches.
Results: A total 13,828 pancreatic cancer patients who underwent PD were included (mean age 66.1; 52.3% male); 2336 (16.9%) were discharged early. 11,507 underwent an MIS approach (8.3%). In the whole group analysis, prior chemotherapy (p<0.001), preoperative biliary stent placement, MIS approach (p<0.001), increased preoperative albumin (p<0.001), a hard pancreatic texture (p=<0.001), and a pancreatojejunal invagination reconstruction (p<0.001) were independently associated with early discharge. Subgroup analysis showed the same predictors for open PD. Within the MIS PD group, only prior chemotherapy was significant (Table 1).
Conclusion: Preoperative and intraoperative factors that predict early discharge after PD include receipt of neoadjuvant therapy, biliary stent status, operative approach, as well as texture and reconstruction of the pancreas. Factors vary by different approaches. This information adds value to current knowledge on patient recovery after PD, focusing on a specific population and different surgical approaches. Moreover, it may help to inform patient expectations, as well as provide surgeons tools to appropriately select postoperative care plans and enhanced recovery pathways.
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