Impact of islet autotransplantation on 30-day post-operative outcomes in patients undergoing Total Pancreatectomy: A NSQIP retrospective cohort analysis of 584 patients

Abstract

BackgroundTotal pancreatectomy (TP) offers a surgical option for refractory pancreatitis, yet confers substantial long-term morbidity associated with resultant diabetes. While total pancreatectomy with islet autotransplantation (TPIAT) offers an intuitive solution, data evaluating its safety have been limited to single-center studies. The aim of this study is to evaluate whether the addition of islet autotransplantation to TP confers additional post-operative morbidity within the 30-day post-operative period. MethodsThis is a retrospective cohort study of prospectively collected cases from the National Surgical Quality Improvement Program (NSQIP) database. Cases of TP with or without islet autotransplantation from 2016 – 2021 were included. Baseline demographics, and a comprehensive list of 30-day postoperative outcomes were evaluated. Multivariable logistic regression models were constructed to evaluate the impact of each factor on 30-day complications. ResultsA total of 584 cases were included with 171 (29.2%) patients undergoing TPIAT. TPIAT patients were younger (58.8 vs. 39.5; p < 0.0001), and had lower incidences of pre-existing diabetes (41.4% vs. 19.9%; p < 0.0001) and hypertension (48.2% vs. 24.6%; p <0.0001). TPIAT cohort had longer length of stay (10.3 days vs.12.2 days; p = 0.0006). There was no difference in overall rates of serious complications between the two cohorts (50.1% vs. 45.0%; p = 0.263). After adjusting for demographic differences between cohorts using multivariable logistic regression models, TPIAT was not associated with serious complications (OR 0.71; p=0.168) compared to TP alone. ConclusionThe results from this study suggest that TPIAT does not appear to be associated with increased 30-day morbidity, and should be considered in patients to mitigate the long-term morbidity associated with diabetes mellitus post TP.