Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2019; 11(9): 365-372
Published online Sep 27, 2019. doi: 10.4240/wjgs.v11.i9.365
Comparison of treatment modalities in pancreatic pseudocyst: A population based study
Yanting Wang, Yazan Abu Omar, Rohit Agrawal, Zimu Gong
Yanting Wang, Yazan Abu Omar, Rohit Agrawal, Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
Zimu Gong, Department of Internal Medicine, AMITA Health St. Joseph Hospital -Chicago, Chicago, IL 60657, United States
Institutional review board statement: The subject of this study is an open database (National Inpatient Sample). Therefore, the study is not considered as “research conducted on humans” and the statement is not applicable to our study.
Informed consent statement: The subject of this study is a public database (National Inpatient Sample). Therefore, the study is not considered as “research conducted on humans” and the statement is not applicable to our study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zimu Gong, MD, Doctor, Zimu Gong, Internal Medicine, AMITA Health St. Joseph Hospital, chicago 60657, IL, United States. Zimu.Gong@amitahealth.org
Telephone: +1-773-6653000
Received: July 3, 2019
Peer-review started: July 14, 2019
First decision: August 2, 2019
Revised: September 3, 2019
Accepted: September 12, 2019
Article in press: September 12, 2019
Published online: September 27, 2019
ARTICLE HIGHLIGHTS
Research background

Current therapeutic techniques for pancreatic pseudocyst include surgical management with a laparoscopic approach or an open surgical procedure, percutaneous catheter drainage and endoscopic drainage.

Research motivation

The best therapeutic technique for pancreatic pseudocyst remains controversial. We are motivated to investigate whether different treatment approaches affect inpatient outcome.

Research objectives

The objectives of this study are to investigate inpatient outcome of different treatment approaches in treating pancreatic pseudocyst.

Research methods

Here we conducted a retrospective analysis of pancreatic pseudocyst-associated hospitalizations using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. International Classification of Diseases (ICD)-10 clinical modification and procedure codes are used.

Research results

A total of 7060 patients meeting the above criteria were identified. Our study revealed laparoscopic approach associated with the lowest rate of RBC transfusion (P < 0.001), and it had lower short-term complications including acute renal failure (P = 0.01), urinary tract infection (P = 0.01), sepsis (P < 0.001) and acute respiratory failure (P = 0.01). Laparoscopic surgical approach associated with the shortest mean length of stay (P = 0.009), and it had the lowest total charge (P = 0.03). All three modalities have similar inpatient mortality (P = 0.28). The study also revealed that percutaneous drainage associated with more emergent admission (P < 0.001), rural hospital performs the most open surgical drainage (P < 0.001) and patients who received laparoscopic drainage are more likely to be discharged home (P < 0.001).

Research conclusions

The study found that laparoscopic drainage of pancreatic pseudocysts associated with the least short-term complications and had better outcomes comparing to percutaneous and open surgical drainage from 2016 National Inpatient Sample (NIS) database. Laparoscopic surgical approach associated with the shortest mean length of stay. With the shorter length of stay, lower hospitalization cost, and least post-operative complications, we believe laparoscopic drainage is the most cost-effective modality among the three.

Research perspectives

Our study is limited by its retrospective nature and the limitation of ICD-10 in which the procedure code for endoscopic drainage is not established until 2017. Also, long term outcome is not available in the NIS database. Further studies especially randomized clinical trials should be conducted to determine the best treatment modality.