Rates of hospitalization pre- and post-total pancreatectomy with islet autotransplantation for patients with pancreatitis

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BACKGROUND: Total pancreatectomy and islet autotransplantation (TPIAT) is a specialized procedure for patients with chronic (CP) and recurrent acute pancreatitis (RAP) experiencing intractable pain and reduced quality of life. Hospitalizations for pancreatitis are common before TPIAT. However, data comparing hospitalization patterns before and after TPIAT remain limited. METHODS: This multicenter, prospective observational study of TPIAT (POST) enrolled 380 patients (age 26 (15, 43 years), 34% pediatric, 62% female) from 12 centers who underwent TPIAT for CP or RAP. Data were collected through patient self-report and electronic medical record confirmation for an 18-month period pre-TPIAT and post-TPIAT at 6 months, 1 year, and then yearly up to 4 years after TPIAT. RESULTS: Proportion of participants reporting any hospitalizations and median hospitalizations per year decreased after TPIAT. Percent with hospital admissions decreased from 86.8% in the 18 months prior to TPIAT to 47.3%, 31.2%, 31% and 30.8% at 1-, 2-, 3-, and 4-year follow-up intervals, respectively, with median hospitalizations per year decreasing from 2 (1, 4) to 0 (0, 2) at 1 year and 0 (0, 1) at each of 2-, 3-, and 4-year post-TPIAT (p < 0.0001 for all). Median cumulative days in hospital decreased from 8 to 0 days at all intervals (p < 0.001 for all). Hospitalization risk was increased with ongoing opioid use at the 1-2-year and 2-3-year follow-up intervals (p = 0.009 and p = 0.005) but was not associated with insulin use post-TPIAT. Emergency department and office visits decreased after TPIAT at all follow-up intervals (p < 0.001) as did proportion of participants with cross-sectional imaging. Abdominal reoperations occurred in about 38% by Kaplan-Meier estimate by 4 years post-TPIAT. CONCLUSION: Hospitalizations, emergency room visits, and office visits decreased after TPIAT when compared to baseline. Persistent opioid use after TPIAT was associated with increased admissions up to 3 years post-TPIAT.

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