Short Term Morbidity Following Total Pancreatectomy and Auto Islet Transplantation; A National Surgical Outcomes Review.

Author(s):
Victor R. Vakayil; Melena Bellin; Gregory Beilman; James Harmon

Background:

Total pancreatectomy with auto-islet transplantation(TPIAT) is an effective surgical approach to manage the disabling complications of chronic or acute recurrent pancreatitis. Fewer than 1000 procedures have been reported to date. Immediate post-surgical morbidity rates varies based on the reporting institution.

Hypothesis:

Our objective was to quantify short-term surgical morbidity following TPIAT from a national surgical outcomes database and identify independent pre-operative predictors of post-surgical infectious complications(PSIC).

Methods:

ACS NSQIP database was reviewed from 2005-2015 to identify all patients who underwent a TPIAT. Patients with malignant disease were excluded from the analysis. Patient demographics, pre-operative co-morbidities, laboratory variables, postoperative 30-day mortality, and overall morbidity outcomes were evaluated. PSIC was defined as a composite categorical outcome that included superficial, deep and organ space infections, pneumonias, urinary tract infections and post-operative sepsis and shock. Univariate analysis followed by multivariate logistic regression was performed to identify independent predictors of PSIC.

Results:

A total of 384 patients met our inclusion criteria, with a mean age of 41.7 ± 12.7; predominantly female (70.3%) and Caucasian (81.3%). Mortality rate at 30 days was 0.8%(N=3) with an overall morbidity rate of 36.2%( N=139). PSIC rate was 28.9%( N=111) whereas superficial and deep surgical site infections rates were 6.5%(N=25) and 2.3%(N=9) respectively. Organ space infections, pneumonias, UTI’s, sepsis and septic shock rates were 9.1%(N=35), 8.5%(N=33), 5.2%(N=20), 11.5%(N=45%), 1.8%( N=7%), respectively. Post-operative bleeding requiring blood transfusion was present in 27.1% (N=104) of patients. On univariate analysis emergency surgery status, increased surgical wound classification, ASA scores ≥2, decreased pre-operative sodium, increased alkaline phosphatase levels and increased intraoperative time were associated with an increased PSIC rate. On the multivariate model, increased operative time was independently associated with an increased risk of developing a PSIC (OR: 1.02, 95% CI 1.01- 1.04, Hosmer-Lemeshow ꙋ²= 5.04, P= 0.7).

Conclusions:

TPIAT is associated with low 30-day mortality and significant postoperative morbidity. Postoperative bleeding, sepsis and organ space infection contribute significantly to postoperative morbidity.