Textbook outcome in surgery for chronic pancreatitis: An analysis of 622 patients

Textbook outcome is a comprehensive assessment of surgical performance that reflects the most desirable surgical outcomes. Although it has been utilized in various surgical fields, its relevance in surgery for chronic pancreatitis has not been explored. The aim of the present study is to evaluate the rate of textbook outcome in patients undergoing surgery for chronic pancreatitis and to identify predictors for textbook outcome failure.

This is a single-center retrospective observational study. Consecutive patients with chronic pancreatitis undergoing surgery from January 2008 to July 2025 were included in the present study. Malignancy in the background of chronic pancreatitis was excluded. Textbook outcome was defined according to the criteria described by the Dutch Pancreatic Cancer Group. Univariable and multivariable logistic regression analyses were performed to identify predictors for textbook outcome failure.

The cohort included 622 patients, and a total of 461 patients (74.1%) achieved textbook outcome. Major morbidity occurred in 62 patients (9.96%) with an in-hospital mortality rate of 1% (n = 6). Rates of postoperative pancreatic fistula, hemorrhage, and readmission were 6.3%, 4.5%, and 2.4%, respectively. On multivariable analysis, prior endoscopic therapy (odds ratio, 2.087; 95% confidence interval, 1.296-3.360; P = .002), perioperative blood transfusion (odds ratio, 2.556; 95% confidence interval, 1.396-4.680; P = .002), and increased operative times (odds ratio, 0.996; 95% confidence interval, 0.992-1.000; P = .029) were associated with failure to achieve textbook outcome, whereas female sex predicted better textbook outcome rates (odds ratio, 0.456; 95% confidence interval, 0.274-0.759; P = .003).

Textbook outcome can be achieved in a significant subset of patients undergoing surgery for chronic pancreatitis. By minimizing blood transfusion and restricting endoscopic interventions prior to surgery, further improvement of textbook outcome can be achieved.