A Study on the Effect of Patient Characteristics, Geographical Utilization, and Patient Outcomes for Total Pancreatectomy Alone and Total Pancreatectomy With Islet Autotransplantation in Patients With Pancreatitis in the United States

Abstract

Objectives A selective therapy for pancreatitis is total pancreatectomy and islet autotransplantation. Outcomes and geographical variability of patients who had total pancreatectomy (TP) alone or total pancreatectomy with islet autotransplantation (TPIAT) were assessed. Methods Data were obtained from the Healthcare Cost and Utilization Project National Inpatient Sample database. Weighed univariate and multivariate analyses were performed to determine the effect of measured variables on outcomes. Results Between 2002 and 2013, there were 1006 TP and 825 TPIAT in patients with a diagnosis of chronic pancreatitis, and 1705 TP and 830 TPIAT for any diagnosis of pancreatitis. The majority of the TP and TPIAT were performed in larger urban hospitals. Costs were similar for TP and TPIAT for chronic pancreatitis but were lower for TPIAT compared with TP for any type of pancreatitis. The trend for TP and TPIAT was significant in all geographical areas during the study period. Conclusions There is an increasing trend of both TP and TPIAT. Certain groups are more likely to be offered TPIAT compared with TP alone. More data are needed to understand disparities and barriers to TPIAT, and long-term outcomes of TPIAT such as pain control and glucose intolerance need further study.

Association of social determinants of health with late diagnosis and survival of patients with pancreatic cancer

“…Prior studies have shown that race is an independent predictor of a late diagnosis of PC and poor survival in all stages (20)(21)(22)(23)(24). In these studies, the survival differences by race were driven largely by differences in surgery and treatment rates in early stage or potentially curative disease settings (3,4,12,25).…”

“…Hispanics have a heterogeneous ancestry, including Indigenous, Caucasian, and African ancestry. Since other studies have evaluated this ethnic group (24,29), we chose to focus on the differences between Black vs. White patients irrespective of ethnicity, as we believe this would partially eliminate biases from heterogeneous ancestry. We acknowledge this is not the generally accepted standard evaluation of race/ethnicity and that even black ancestry has significant heterogeneity.…”

En bloc liver and pancreas transplantation after total pancreatectomy with autologous Islet transplantation

“…Recognizing these advantages, the majority of commercial insurance carriers in the United States and in several European countries should consider reimbursing IAT. Hopefully, the multicenter TPIAT study, which is currently underway, will provide further evidence to change the position of the remaining insurance carriers (notably the Centers for Medicare and Medicaid Services) and clinicians who have not yet recognized the benefits of IAT [ 9 ].…”

The Future of Clinical Islet Transplantation in the United States

“…Our own group has provided autologous islets for 152 TPAITs since 2007, including 26 juvenile patients (under 18 years of age) as young as 7 years [9]. The trend towards TP and TPAIT can be observed in all geographical areas of the US [15]. Improvements to the procedure have resulted in better outcomes over time [16].…”