Variation in Hospital Utilization of Minimally Invasive Distal Pancreatectomy for Localized Pancreatic Neoplasms

  • Ryan J. Ellis
  • Lindsey M. Zhang
  • Clifford Y. Ko
  • Mark E. Cohen
  • David J. Bentrem
  • Karl Y. Bilimoria
  • Anthony D. Yang
  • Mark S. Talamonti
  • Ryan P. MerkowEmail author
Original Article



Minimally invasive distal pancreatectomy (MIDP) for localized neoplasms has been demonstrated to be feasible and safe. However, national adoption of the technique is poorly understood. Objectives of this study were to identify factors associated with use of minimally invasive distal pancreatectomy for localized neoplasms and assess hospital variation in MIDP utilization.


Retrospective cohort study of patients with pancreatic cysts, stage I pancreatic ductal adenocarcinoma, and stage I pancreatic neuroendocrine tumors undergoing distal pancreatectomy from the ACS NSQIP Pancreas Targeted Dataset. Factors associated with use of MIDP were identified using multivariable logistic regression and hospital-level variation was assessed.


Analysis included 3,059 patients at 139 hospitals. Overall, 64.5% of patients underwent minimally invasive distal pancreatectomy. Patients were more likely to undergo MIDP if they had lower ASA classification (P = 0.004) or BMI ≥ 30 (P < 0.001) and less likely if they had pancreatic adenocarcinoma (P < 0.001). There was notable hospital variability in utilization (range 0 to 100% of cases). Hospital-level utilization of minimally invasive distal pancreatectomy did not appear to be driven by patient selection, as hierarchical analysis demonstrated that only 1.8% of observed hospital variation was attributable to measured patient selection factors.


Utilization of MIDP for localized pancreatic neoplasms is highly variable. While some patient-level factors are associated with MIDP use, hospital adoption of MIDP appears to be the primary driver of utilization. Monitoring hospital-level use of MIDP may be a useful quality measure to monitor uptake of emerging techniques in pancreatic surgery.


Health services research Surgical quality Pancreatic surgery Distal pancreatectomy 



American College of Surgeons


Death or serious morbidity


Minimally invasive distal pancreatectomy


National Surgical Quality Improvement Program


Open distal pancreatectomy


Pancreatic ductal adenocarcinoma


Pancreatic neuroendocrine tumor


Funding Information

RJE is supported by a postdoctoral research fellowship (Agency for Healthcare Research and Quality [AHRQ] 5T32HS000078). ADY is supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (K08HL145139). RPM is supported by the Agency for Healthcare Quality (K12HS026385) and an Institutional Research Grant from the American Cancer Society (IRG-18-163-24).

Compliance with Ethical Standards


The American College of Surgeons as an organization had no role in the design and conduct of the study; analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Views expressed in this work represent those of the authors only.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Ryan J. Ellis
    • 1
    • 2
    • 3
  • Lindsey M. Zhang
    • 1
    • 2
    • 4
  • Clifford Y. Ko
    • 1
    • 5
    • 6
  • Mark E. Cohen
    • 1
  • David J. Bentrem
    • 2
    • 3
  • Karl Y. Bilimoria
    • 1
    • 2
    • 3
  • Anthony D. Yang
    • 2
    • 3
  • Mark S. Talamonti
    • 7
    • 8
  • Ryan P. Merkow
    • 1
    • 2
    • 3
    Email author
  1. 1.Division of Research and Optimal Patient CareAmerican College of SurgeonsChicagoUSA
  2. 2.Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Northwestern Institute for Comparative Effectiveness Research in Oncology, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  4. 4.Department of SurgeryUniversity of Chicago MedicineChicagoUSA
  5. 5.Department of Surgery, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  6. 6.VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  7. 7.Department of SurgeryNorthShore University HealthSystemEvanstonUSA
  8. 8.Pritzker School of MedicineUniversity of ChicagoChicagoUSA

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