Contemporary Nationwide Assessment of Resource Utilization and Perioperative Outcomes in Open and Minimally Invasive Pancreaticoduodenectomy.

Abstract

Background: While minimally invasive pancreaticoduodenectomy (MIPD) has historically demonstrated benefits over open pancreaticoduodenectomy (OPD), recent advances in perioperative care and surgical techniques may have impacted the relative advantages of these two approaches. This contemporary analysis examines national trends to assess potential differences in resource utilization metrics along with perioperative outcomes between the two approaches. Methods: We analyzed the Nationwide Inpatient Sample database for cancer patients who underwent pancreaticoduodenectomies from 2016 through 2020. We compared socio-demographics, length of stay (LOS), total charges, and perioperative complications between MIPD and OPD. Results: In this observational study, MIPD was associated with lower total charges ($97,470 vs $126,586), shorter LOS (5.05 vs 7.37 days), and lower odds of perioperative complications (OR 1.40, 95% CI 1.18-1.65) compared to OPD. While total charges increased similarly in both groups over time, a declining trend in LOS was observed for OPD (11.49 to 10.36 days). Non-white race and private/other insurance correlated with longer stays, higher charges, and more complications regardless of surgical approach. Conclusions: Despite the gradual improvements in LOS observed with OPD, MIPD demonstrated advantages in resource utilization metrics, indicating potential for reduced healthcare utilization and costs compared to the open surgical approach during the study period. Continued prospective investigation is warranted to comprehensively evaluate MIPD's value proposition.