National Pancreatic Fistula Rates after Minimally Invasive Pancreaticoduodenectomy: A NSQIP Analysis

Abstract

There is a substantial learning curve associated with minimally invasive pancreaticoduodenectomy (MIPD). We sought to determine if national MIPD pancreatic fistula rates are decreasing with time. All patients undergoing elective MIPD and accrued into the pancreatectomy-targeted NSQIP database between 2014 and 2017 were included in the study. Trends in MIPD outcomes by year were examined using Cochran-Armitage and Mann-Kendall tests for trend. Multivariable logistic regression was used to assess for an independent association between increasing year of operation and pancreatic fistula. There were 1,096 patients who underwent MIPD between 2014 and 2017. There was a significant trend toward decreasing pancreatic fistula rates (23.6% vs 19.2% vs 14.9% vs 12.7%, p<0.01) and clinically relevant pancreatic fistula rates (18.3% vs 15.4% vs 11.1% vs 9.1%, p < 0.01) by increasing year. In multivariable analysis, increasing year of operation was independently protective against pancreatic fistula (odds ratio [OR] 0.76 per year, p < 0.01) and clinically relevant pancreatic fistula (OR 0.73 per year, p < 0.01). Patients without pancreas ducts <3 mm or soft pancreas gland texture experienced a significant decreasing trend in pancreatic fistula rates (23.7% vs 13.2% vs 10.3% vs 8.0%, p < 0.01) and clinically relevant pancreatic fistula rates (18.3% vs 9.1% vs 5.2% vs 6.0%, p < 0.01), respectively, by increasing year. However, there was not a significant trend in pancreatic fistula rate or clinically relevant fistula rate among patients having either pancreas ducts < 3 mm or soft gland texture. National MIPD pancreatic fistula rates are improving with time. A major contributing factor for this finding is better outcomes in patients who are at lower risk of pancreatic fistula, which could be a reflection of evolving minimally invasive anastomotic techniques.