Failure-to-rescue after pancreatectomy for pancreatic cancer in the United States: National Inpatient outcomes, 2018–2023.

Abstract

e23232 Background: Pancreatectomy for pancreatic cancer carries substantial postoperative morbidity. As operative mortality has declined, inpatient outcomes increasingly depend on the ability to recognize and manage major postoperative complications; contemporary national benchmarks for these rescue outcomes remain limited. Methods: A retrospective analysis of the 2018–2023 National Inpatient Sample identified adult pancreatectomy hospitalizations for pancreatic cancer using ICD-10-CM/PCS codes. Major postoperative complications were defined using diagnosis codes, and failure-to-rescue was defined as in-hospital mortality among hospitalizations with ≥1 complication. Survey-weighted logistic regression, restricted to complicated cases, evaluated factors associated with failure-to-rescue while accounting for national weighting, clustering, stratification, patient characteristics, admission factors, hospital features, calendar year, and APR-DRG severity. Results: An estimated 115,385 hospitalizations for pancreatic cancer–related pancreatectomy were identified nationally from 2018–2023. Major postoperative complications occurred in 25.5% of hospitalizations (95% CI 24.9–26.1). Overall in-hospital mortality was 2.3% (95% CI 2.1–2.5). Among hospitalizations with at least one major complication, mortality was 7.7%, corresponding to a failure-to-rescue (FTR) rate of 7.7% (95% CI 7.0–8.4). Across the full cohort, FTR prevalence was 2.0% (95% CI 1.8–2.2). Among complicated hospitalizations, mean length of stay was 12.6 days (95% CI 12.3–12.9). The most common complication domains were acute kidney injury (22.4%; 95% CI 21.2–23.7), respiratory complications (14.5%; 95% CI 13.6–15.6), and infectious or septic complications (13.7%; 95% CI 12.8–14.7). In unadjusted analyses, failure-to-rescue varied by hospital structure, with higher rates at rural and smaller hospitals and lower rates at urban teaching and large hospitals. In adjusted analyses restricted to complicated hospitalizations, increasing age was associated with higher odds of FTR (OR 1.01 per year, 95% CI 1.00–1.02, p = 0.045), while elective admission was associated with lower odds of FTR (OR 0.48, 95% CI 0.38–0.62, p < 0.001). Hospital teaching status, bed size, and geographic region were not independently associated with FTR after adjustment. Conclusions: One-quarter of pancreatectomy hospitalizations were complicated, with a 7.7% failure-to-rescue rate. After adjustment, failure-to-rescue was driven by patient and admission factors rather than hospital structure, establishing contemporary national benchmarks for postoperative rescue after pancreatectomy.