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Whether or Not to Preserve the Spleen: Assessing Outcomes of Distal Pancreatectomy
*Charles E. Thompson, III1, *Sharon K Ong'Uti1, *Gezzer Ortega1, *Tolulope A Oyetunji1, *Ekene A Onwuka2, *Delenya Allen1, *Daniel D. Tran1, Wayne A.i. Frederick1, *Terrence M. Fullum1
1Department of Surgery, Howard University College of Medicine, Washington, DC;2Howard University College of Medicine, Washington, DC
Objective: Spleen-preserving distal pancreatectomy (SPDP) has increased over the past decade. When comparing SPDP and spleen-sacrificing distal pancreatectomy (SSDP), patient outcomes have not been well differentiated. The purpose of this study is to determine differences in hospital outcomes between the SPDP and SSDP using a national inpatient database.
Design: The Nationwide Inpatient Sample (NIS) database (1998-2008) was queried for patients who underwent a distal pancreatectomy (DP). Excluded were patients with splenic pathology, pancreatic malignancy, or trauma-related operations. Bivariate analysis was performed comparing SSDP to SPDP by patient- and hospital-level characteristics. Multivariate regression was done to predict the impact of each technique on outcomes.
Setting: The NIS is an administrative database which represents collated discharge records from approximately 1,000 hospitals across the US.
Patients: Patients undergoing DP.
Main Outcome Primary outcome- mortality; Secondary outcomes-
blood transfusions, and length of stay (LOS).
Results: 3,159 patients met our inclusion criteria representing a national estimate of 15,669. 72.1% and 27.9% patients underwent SSDP and SPDP, respectively. Overall mortality rate was was 1.2%. 10.7% of all patients required blood transfusion and the mean LOS was 10 days. There was no significant difference in mortality or LOS between SSDP and SPDP on unadjusted and adjusted analysis. Among patients receiving SSDP, blood transfusions rates were higher (12% vs. 8%, p= 0.001). On adjusted analysis, there was 49% increased odds of having a blood transfusion with SSDP than SPDP (OR: 1.492638, p= 0.009, 95% CI 1.11-2.01).
Conclusions: Using a national inpatient database, our study demonstrated no significant differences in mortality and LOS between patients undergoing SSDP versus SPDP. SPDP may offer patients an organ preserving procedure with similar outcomes.
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