Introduction: Due to the rarity and indolent natural history of pancreatic neuroendocrine tumors (PNETs), treatment approaches are not yet standardized. Previous studies have shown that there is a survival advantage conferred by primary tumor resection. What remains to be further elucidated is the overall morbidity of resection for this unique subtype of pancreatic tumor. Therefore, the objective of this study is to examine a composite outcome of major post-operative complications, including in-hospital mortality, within this population of patients undergoing surgical resection for PNETs. Methods: This is a retrospective cohort study analyzing all patient discharges recorded as having undergone surgical resection for PNET in the Nationwide Inpatient Sample for the years 1998-2006. Patient discharges were identified using ICD-9-CM diagnosis and procedure codes. The main outcome measure was a composite outcome of significant post-operative complications (infection, myocardial infarction, deep venous thombosis/pulmonary embolism, pneumonia, pulmonary compromise, hemorrhage, reoperation) and in-hospital mortality. Candidate predictors that were evaluated included patient characteristics (sex, age, race, comorbidities as measured in a Charlson score), as well as hospital characteristics (region, location, teaching status). Univariate analyses were performed using chi-square tests. Multivariate analyses were performed to determine which patient and hospital variables were independently associated with the composite outcome. Results: There were 463 (2270 nationally weighted) patient discharges identified with the diagnosis of PNET having undergone a pancreatic resection. Overall post-operative complication rate, including in-hospital mortality, was 13.4%. The majority of these complications involved pulmonary compromise (7.0%) or hemorrhage (2.8%); there was also a 1.8% rate of reoperation. In-hospital mortality rate was 1.7%. On univariate analysis, only Charlson comorbidity score demonstrated a statistically significant relationship with the composite outcome. On logistic regression analysis, controlling for patient and hospital characteristics, factors predictive of increased post-operative complications were male sex (adjusted odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.4), black race (adjusted OR 2.8, 95% CI 1.1-7.5), Charlson score of 1-2 and ≥3 vs score of 0 (adjusted OR 2.2, 95% CI 1.2-4.0 and adjusted OR 4.1, 95% CI 1.7-10.0, respectively). Conclusions: While in-hospital mortality rates are low for surgical resection of PNETs, there is a considerable overall post-operative complication rate associated with these procedures. Factors significantly predictive of worse outcome are male sex, black race, and Charlson comorbidity score >0.
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Apr 30, 2013
Sabrina G Testoni + 6
Open Access