Total pancreatectomy with islet autotransplantation reduces resource utilization in pediatric patients.

ABSTRACT

BACKGROUND: Chronic pancreatitis (CP) is associated with poor quality of life. Total pancreatectomy with islet autotransplantation (TPIAT) has traditionally been reserved for patients with refractory disease. We hypothesized TPIAT would lead to decreased costs and resource utilization after operation in children. METHODS: Retrospective review of 39 patients who underwent TPIAT at a single children's hospital was performed. All inpatient admissions, imaging, endoscopic procedures, and operations were recorded for the year prior to and following operation. Costs were determined from Centers for Medicare and Medicaid Services. RESULTS: Median hospital admissions before operation was 5 (IQR2-7) and decreased to 2 (IQR1-3) after (p < 0.01). Median total cost for the year before operation was $36,006 (IQR$19,914-$47,680), decreasing to $24,900 postoperatively (IQR$17,432-$44,005, p = 0.03). Removing cost of TPIAT itself, total cost was further reduced to $10,564 (IQR$3096-$29,669, p < 0.01). CONCLUSION: In children with debilitating CP, TPIAT has favorable impact on cost reduction, hospitalizations, and invasive procedures. Early intervention at a specialized pancreas center of excellence should be considered to decrease future resource utilization and costs among children.