Hepato-pancreato-biliary
Eleftherios A. Makris, MD PhD
Surgical Oncology Fellow
University of Pittsburgh Medical Center, Pennsylvania, United States
Eleftherios A. Makris, MD PhD
Surgical Oncology Fellow
University of Pittsburgh Medical Center, Pennsylvania, United States
Eleftherios A. Makris, MD PhD
Surgical Oncology Fellow
University of Pittsburgh Medical Center, Pennsylvania, United States
Asmita Chopra, MD (she/her/hers)
Research Resident
University of Pittsburgh Medical Center
Holland, Pennsylvania, United States
Nikhil Tirukkovalur, MD
Research Fellow
University of Pittsburgh Medical Center, United States
Rudy El Asmar, MD PhD
Research Fellow
University of Pittsburgh Medical Center, United States
Aatur Singhi, MD, PhD
Associate Professor of Anatomic Pathology
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Kenneth Lee, MD
Professor of Surgery
University of Pittsburgh Medical Center, United States
Amer H. Zureikat, MD
Professor and Chief
Division of Surgical Oncology, University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Alessandro Paniccia, MD
Assistant Professor of Surgery
Department of Surgery, University of Pittsburgh Medical Center, United States
In surgical outcome registries, the duration of hospitalization, known as Length of Hospital Stay (LOS), is a relevant quality metric. This study delved into the impact of a patient's travel distance from their primary residence to the hospital on the LOS following major elective pancreatic surgery.
We reviewed our institutional database of patients who underwent elective major pancreatectomy (Whipple, distal pancreatectomy with or without splenectomy, total pancreatectomy) via an open or minimally invasive surgery (MIS) approach between 2016 and 2023. Demographic data, surgical parameters, and the distance patients traveled from their primary residence to the hospital were analyzed in relation to LOS. These assessments were conducted through parametric univariate (UVA) and multivariate analyses (MVA). Additionally, the Pearson correlation coefficient was employed to perform correlation analysis.
Of the 926 patients, 47% were females. The mean age of the cohort was 65 ± standard deviation (SD) 11 years. The mean distance traveled was 82 (IQR ± 78) kilometers, and the mean LOS was 8.9 days (IQR ± 8.4 days). Similar LOS was observed for any pancreatectomy performed before or after 2020 (p=0.769). Correlation analysis indicated that for patients undergoing any major pancreatectomy, an increase in LOS was associated with a greater distance traveled (r=0.119, p< 0.001). When data was stratified by procedure type and technical approach, the same correlation was observed only for open Whipple (r=0.191, p=0.002). For any major pancreatectomy, linear regression analysis showed ASA class< 3 (p=0.005), MIS approach (p< 0.001), and distance traveled < 12.5 km (p< 0.001) where independent predictors of shorter LOS on UVA, but only MIS approach (p=0.001) and distance traveled < 12.5 km (p< 0.001) were independent predictors of shorter LOS on MVA. Distance traveled < 12.5 km was the only independent predictor of shorter LOS for any open pancreatectomy (p< 0.001), as well as for MIS pancreatectomy (p=0.019).
Increased travel distance from a patient's primary residence to the hospital was independently associated with increased LOS after a major pancreatectomy. As LOS is a notable quality measure in pancreatic surgery, it is advisable to consider the patient's travel distance as a relevant factor in risk adjustments.