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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Fig. 1

Abbreviations

ACS:

American College of Surgeons

DSM:

Death or serious morbidity

MIDP:

Minimally invasive distal pancreatectomy

NSQIP:

National Surgical Quality Improvement Program

ODP:

Open distal pancreatectomy

PDAC:

Pancreatic ductal adenocarcinoma

PNET:

Pancreatic neuroendocrine tumor

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Funding

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).

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Correspondence to Ryan P. Merkow.

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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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Meeting Presentation: This work was presented as a poster at the Americas Hepato-Pancreato-Biliary Association 2019 Annual Meeting in Miami, FL.

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Ellis, R.J., Zhang, L.M., Ko, C.Y. et al. Variation in Hospital Utilization of Minimally Invasive Distal Pancreatectomy for Localized Pancreatic Neoplasms. J Gastrointest Surg 24, 2780–2788 (2020). https://doi.org/10.1007/s11605-019-04414-7

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Keywords

  • Health services research
  • Surgical quality
  • Pancreatic surgery
  • Distal pancreatectomy