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positioning as potentially causative risk factors for VTE due to impaired lower extremity venous return. However, the influence of operative technique on VTE risk after DP is unknown. This study aims to examine the association between minimally invasive surgery (MIS) technique and the development of post-operative VTE after DP. Methods: Patients who underwent DP (2014e2015) were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) pancreas-specific database. The primary outcome examined was the association between operative technique (MIS vs open) and the development of VTE. Subset analysis was performed to examine the incidence of pre and post-hospital discharge VTE events. Multivariable logistic regression analysis was used to compute adjusted odds ratios (aOR) to identify independent associations in outcomes of interest. Results: A total of 3,558 patients were included in the analysis. Of these, 47.8% (N = 1,702) underwent MIS DP. Post-operative VTE occurred in 126 (3.5%) patients, with 71 (56.3%) VTE events diagnosed after hospital discharge. When compared to open surgery, MIS patients had a lower incidence of major comorbidities (active cancer, smoking, malnutrition, advanced ASA score) and were less likely to receive neoadjuvant chemotherapy or radiation prior to surgery. After adjusting for significant covariates, MIS approach was independently associated with the development of any post-operative VTE event (aOR 1.60 [1.06e 2.40], p = 0.025). Subset analysis also identified that MIS technique was associated with an increased risk of postdischarge VTE (aOR 1.80 [1.05e3.08], p = 0.033), whereas there was no increased incidence of in-hospital VTE rates between open and MIS groups (p = 0.487). VTE was associated with numerous post-operative complications including pneumonia, unplanned intubation, prolonged mechanical ventilation, and cardiac arrest. Conclusion: MIS modalities are typically associated with fewer post-operative complications and improved patient outcomes. However, this study identifies a novel association between MIS technique and an increased risk for developing post-operative VTE in patients undergoing DP nationwide. Specifically, MIS DP was associated with a higher likelihood of developing VTE after hospital discharge. These data highlight an important disparity between MIS and open DP patients that may be attributable to physiologic changes due to surgical technique or provider oversights in adherence to established VTE prophylaxis guidelines. Further studies to examine potential etiologies for this phenomenon are needed to improve patient outcomes after DP.

Background:In patients undergoing pancreatoduodenectomy, non-home discharge is common and often results in an unnecessary delay in hospital discharge. This study aimed to develop and validate a preoperative prediction model to identify patients with a high likelihood of non-home discharge following pancreatoduodenectomy. Methods:Patients undergoing pancreatoduodenectomy from 2013-2018 were identified using an institutional database. Patients were categorized according to discharge location (Home vs. Non-Home). Preoperative risk factors, including social determinants of health associated with nonhome discharge, were identified using Pearson's chi-squared test and then included in a multiple logistic regression model. A training cohort composed of 80% of the sampled patients was used to create the prediction model, and validation carried out using the remaining 20%. Statistical significance was defined as P < 0.05. Results:766 pancreatoduodenectomy patients met the study criteria for inclusion in the analysis (nonhome: 126; home: 640). Independent predictors of non-home discharge on multivariable analysis were age, marital status, mental health diagnosis, functional health status, dyspnea, and chronic obstructive pulmonary disease. The prediction model was then used to generate a nomogram to predict likelihood of non-home discharge. The training and validation cohorts demonstrated comparable performances with an identical area under the curve (0.81) and an accuracy of 84%. Conclusion:A prediction model to reliably assess the likelihood of non-home discharge after pancreatoduodenectomy was developed and validated in the present study.