Pancreatic Cancer: An Overview of National Trends and Adverse Outcomes in the United States From 2008 to 2017

Introduction: Pancreatic cancer is the third leading cause of cancer death in the US. However, there is paucity of data on pancreatic cancer hospitalizations. Methods: We analyzed the Nationwide Inpatient Sample (NIS) from 2008–2017 to identify all adult hospitalizations (≥ 18 years) of pancreatic cancer. We calculated the frequency of hospitalization for age, gender, race, hospital characteristics, median household income, insurance status, type of admission, and disposition status. We also assessed length of stay (LOS), discharge patterns and indications for admissions (emergent vs elective). The analysis was performed via SAS 9.3 using Cochrane-Armitage trend test for categorical variables and Wilcoxon Rank Sum Test for continuous variables. Results: We noted significant variance but an overall increase in the total number of pancreatic cancer hospitalizations from 37,123 in 2008 to 37,635 in 2017 (p < 0.0001) (Table 1). Patients aged 65–79 years had the highest rate of hospitalizations with a rising trend from 41.6% in 2008 to 45.9% in 2017 (p < 0.0001). In 2008, a female predominance was noted (51.9% vs 48.1%, p < 0.0001); however, there was a shift to male predominance in 2012 (50.9% vs 49.1%, p < 0.0001) and thereafter (Table 1). Whites made up a majority of the study population and the South hospital region saw the most hospitalizations (Table 1). Emergent or urgent hospitalizations decreased from 54.1% in 2008 to 50.7% in 2017 (p < 0.0001) while elective hospitalizations increased from 45.9% in 2008 to 49.3% in 2017 (p < 0.0001). The mean LOS decreased from 8.4 days in 2008 to 7 days in 2017 (p < 0.0001). Furthermore, there was an increase in home discharges from 72% in 2008 to 76.2% in 2017 (p < 0.0001) while inpatient mortality decreased from 10.1% in 2008 to 7.6% in 2017 (p < 0.0001) for these hospitalizations. Conclusion: In the US, there was significant variance but an overall increase in the total number of pancreatic cancer hospitalizations between 2008–2017 with a rising prevalence noted in men. This may in part be secondary to increased exposure to modifiable risk factors such as smoking and alcohol use. During 2008–2017, there was a decrease in the mean LOS and inpatient mortality for pancreatic cancer hospitalizations. This may reflect early detection and improvements in therapeutic management; however, it may also, in part, be due to increased home discharges per patient preference.Table 1.: Biodemographic characteristics and outcomes of pancreatic cancer hospitalizations in the United States from 2008 to 2017.