Perioperative outcomes for open distal pancreatectomy: current benchmarks for comparison.

BACKGROUND: Open distal pancreatectomy (ODP) outcomes have largely relied on single-institution data from high-volume, tertiary centers. To provide contemporary, national benchmarks of ODP outcomes, we examined the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
METHODS: Using the ACS-NSQIP database (2005-2007), we identified 868 cases of ODP. Operative time, intraoperative transfusion, and length-of-stay (LOS) data were compiled. Univariate and multivariate analyses were performed adjusting for age, body mass index, diagnosis, creatinine, albumin, hematocrit, and American Society of Anesthesiologists (ASA) classification for likelihood of any postoperative complication and severe complication (composite endpoint: organ space surgical site infection, reoperation, or death).
RESULTS: Thirty-day overall complication, severe complication, and mortality rates were 27.2%, 11.6%, and 1%, respectively. Mean operative time was 206 min (±86), 18.1% patients required intraoperative red blood cell transfusion (median 2 units), and median LOS was 6 days. Predictors of any complication or severe complication were renal insufficiency, hypoalbuminemia, and worsening ASA classification. Malignant diagnosis was not associated with poorer outcomes. DISCUSSION: ODP remains the gold standard for lesions of the pancreatic body or tail. The current analysis reflects nationwide data that may serve as current benchmarks for both open and laparoscopic techniques.