Rising Interventions and Persistent Mortality: National Trends in Pancreatic Malignancy in the United States

Introduction: Pancreatic cancer, a highly aggressive malignancy, continues to pose significant challenges in treatment outcomes and mortality rates. Despite advancements in interventions, the incidence of pancreatic cancer remains a growing concern, necessitating a deeper understanding of the trends in hospital admissions and associated procedures. Our study aims to examine the latest trends in interventions and in-hospital mortality for pancreatic cancer in the US (Figure 1). Methods: We utilized the 2015-2020 National Inpatient Sample database and the ICD-10, Clinical Modifications coding system to identify adult patients admitted with a primary diagnosis of malignant neoplasm of the pancreas. In addition, we queried for associated procedures (total excision, local excision, or Whipple procedure). Results: Our study analyzed a total of 570,179 admissions for malignant pancreatic cancer. Among these admissions, 69.11% (394,064) were patients of the White race. Additionally, more males (52%) than females were admitted due to pancreatic cancer. In terms of procedures, the most common procedure performed was total excision, accounting for 7.31% of cases. This was followed by the Whipple procedure, which constituted 3.24% of cases. Local excision was the least procedure performed, which accounted for 1.71% of cases. We observed that the mortality rate associated with pancreatic cancer decreased only slightly from 2015 to 2020. Total excision frequency remained constant overall, with a slight dip and subsequent increase from 2017 to 2020. On the other hand, the number of local excisions decreased significantly by two-thirds in 2020 compared to 2015. In contrast, the Whipple procedure showed a gradual upward trend from 2018 to 2020 (Table 1). Conclusion: In conclusion, our study revealed persistent mortality rates in pancreatic cancer despite increasing interventions. Total excision remained the most common procedure, with a stable trend. However, local excisions experienced a significant decline, while Whipple procedures showed a gradual upward trend in recent years. These findings highlight the ongoing challenges in managing pancreatic cancer and the need for continued research and improved treatment strategies.Figure 1.: Mortality and procedure trends of pancreatic cancer in the United States, national inpatient sample database 2015 - 2020. Table 1. - Malignant Neoplasm of the Pancreas, National Inpatient Sample Database 2015-2020 Total malignant neoplasm of the pancreas: 2015-2020 570179 Age 69 (61-76) Females 273015 (48%) Males 297164 (52%) Race Whites 394065 (69%) Blacks 76745 (14%) Hispanics 45495 (8%) Others 37494 (7%) Total excision 41665 (7.31%) Local excision 9760 (1.71%) Whipple procedure 18455 (3.24%) In hospital mortality 42470 (7.45%) LOS 4 days (3-7) Total hospital cost $11313.57 (6487.01-20389.37)