Surgical management of chronic pancreatitis: current utilization in the United States

BackgroundSurgical intervention is uncommon in chronic pancreatitis. Literature largely describes single institution or international experiences. This study describes US‐based chronic pancreatitis surgical management.MethodsRetrospective analysis of chronic pancreatitis patients in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007–2011. Patients with malignancy or congenital abnormalities were excluded. Univariate analysis using the chi‐square test. The number of readmissions, inpatient length of stay and cost using Wilcoxon's signed‐rank test. Multivariate analysis of surgery by logistic regression.ResultsTwenty‐one thousand four hundred and forty‐five patients with chronic pancreatitis. 10.8% (2 307) underwent surgery including 1652 cholecystectomies, 564 drainage procedures and 498 pancreatectomies. Procedures decreased from 12.1% to 8.3% over time (P< 0.001), but intervention within 3 months increased (7.2% to 8.4%; P = 0.017). 15.3% (3 278) had pancreatic cysts/pseudocysts and 43.4% (9 312) had diabetes. The median numbers of admissions were 2 [interquartile range (IQR) 1,5] and 3 (IQR 2,7) among non‐surgical and surgical patients, respectively (P< 0.001). Predictors of surgery were fewer co‐morbidities, private insurance, and either diabetes mellitus or pancreatic cyst/pseudocyst.ConclusionChronic pancreatitis leads to numerous inpatient readmissions, but surgical intervention only occurs in a minority of cases. Complicated patients are more likely to undergo surgery. The complexities of chronic pancreatitis management warrant early multidisciplinary evaluation and ongoing consideration of surgical and non‐surgical options.