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Ari D. Brooks, MD; Stuart G. Marcus, MD; Catherine Gradek, MD; Elliot Newman, MD; Peter Shamamian, MD; Thomas H. Gouge, MD; H. Leon Pachter, MD; Kenneth Eng, MD

Arch Surg. 2000;135:823-830.

Hypothesis  Decreased length of stay (LOS) after pancreatoduodenectomy is due to multiple factors, including a lower complication rate and more efficient perioperative care for all patients, with and without complications.

Design  A retrospective review, validation cohort.

Setting  A single university hospital referral center.

Patients  A consecutive sample of patients undergoing pancreatoduodenectomy from January 9, 1986, to December 21, 1992 (group 1 [n=104]) and from February 16, 1993, to November 9, 1998 (group 2 [n=111]).

Intervention  Mann-Whitney test and logistic regression analysis applied to clinical variables and LOS.

Main Outcome Measures  Difference in median LOS between early and late groups and identification of factors predictive of decreased LOS.

Results  Total LOS decreased between the 2 groups (26 days [range, 13-117 days] vs 15 days [range, 5-61 days]; P<.001), with a decrease in preoperative (4 days [range, 0-28 days] vs 2 days [range, 0-36 days]; P<.001) and postoperative (19 days [range, 11-95 days] vs 12 days [range, 4-58 days]; P<.001) LOS (data given for group 1 vs group 2). Major complications decreased from 49% in group 1 to 25% in group 2 (P<.001). Postoperative LOS decreased for patients with (25 days [range, 15-95 days] vs 20 days [range, 8-58 days]; P=.05) and without (15 days [range, 11-47 days] vs 11 days [range, 4-55 days]; P<.001) major complications (data given for group 1 vs group 2). Multivariate analysis identified age (P=.01), pancreatic fistula (P<.001), delayed gastric emptying (P<.001), biliary complications (P<.001), operative time (P<.005), extra-abdominal infection (P<.005), use of a percutaneous stent (P=.04), and year of operation (P<.001) as independent predictors of total LOS.

Conclusion  A reduction in complications in combination with factors leading to a streamlining of perioperative care has contributed to the decreased LOS after pancreatoduodenectomy.

From the Department of Surgery, New York University School of Medicine, New York.

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