Published online Sep 27, 2019. doi: 10.4240/wjgs.v11.i9.365
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
Processing time: 87 Days and 2.8 Hours
Current therapeutic techniques for pancreatic pseudocyst include surgical management with a laparoscopic approach or an open surgical procedure, percutaneous catheter drainage and endoscopic drainage.
The best therapeutic technique for pancreatic pseudocyst remains controversial. We are motivated to investigate whether different treatment approaches affect inpatient outcome.
The objectives of this study are to investigate inpatient outcome of different treatment approaches in treating pancreatic pseudocyst.
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.
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).
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.
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.