Anmol Mittal, MD, Sushil Ahlawat, MD; Rutgers New Jersey Medical School, Newark, NJ
Introduction: Pancreatic cancer is the fourth leading cause of death by cancer in the United States. Typical presentation includes non-specific symptoms such as jaundice, epigastric pain, and weight loss. These symptoms have a poor positive predictive value for detecting pancreatic cancer. If ultrasound and computer tomography allow visualization of a resectable pancreatic mass, the next step is surgical intervention. However, when there is insufficient evidence, a biopsy is performed either percutaneously, endoscopically, or surgically. We hypothesize that a patient’s hospital length of stay (LOS) is different depending on the method of biopsy. Methods: A retrospective analysis of the National Inpatient Sample 2001-2013 database was conducted. Patients with a diagnosis of pancreatic cancer of all locations and types were extracted using the International Classification of Disease, Ninth Revision (ICD-9) codes. Codes for endoscopic or percutaneous fine-needle aspiration and open surgical biopsy of the pancreas were identified using ICD-9 procedural codes. A one-way analysis of variance (ANOVA) test was used to compare the means for the length of stay in the different biopsy methods, with a significance of p < 0.001. Results: The total number of patients in our study population was 64,656. There were 3,407 patients who received endoscopic biopsies, 49,230 patients who received percutaneous biopsies, 11,008 patients who received surgical biopsies, and 1012 patients who received a combination of the three. The mean (M) length of stay and standard deviations for endoscopic biopsies were, M = 8.61, SD = 8.26, for percutaneous biopsies M = 9.20, SD = 7.92, for surgical biopsies M = 12.81, SD = 10.36, and for a combination of the biopsies M= 14.77, SD =9.63. The ANOVA was significant with a p < 0.001. Discussion: The LOS for patients diagnosed with pancreatic cancer who underwent different biopsy types was significantly different. Patients who underwent an endoscopic biopsy have the shortest LOS compared to those who underwent a percutaneous biopsy, surgical biopsy, or a combination of the three by at least one day. Patients who underwent surgical biopsies stayed an average of at least three more days compared to those with percutaneous and endoscopic biopsies. Those who underwent more than one biopsy type had the greatest LOS. This may represent considerations physicians must take when deciding between different diagnostic options available.
Table 1. Average Length of Stays for Endoscopic, Percutaneous, and Surgical Biopsy Patients
Disclosures: Anmol Mittal indicated no relevant financial relationships. Sushil Ahlawat indicated no relevant financial relationships.