{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:12:43Z","timestamp":1758672763562,"version":"3.44.0"},"reference-count":51,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Total pancreatectomies (TP) are rare high\u2010risk operations requiring complex postoperative management. Hospital factors are known to impact pancreatectomy outcomes, but the role of patient socioeconomic status on TP outcomes remains poorly understood. This retrospective study assesses the impact of income and insurance on 90\u2010day mortality after TP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adults (\u2265\u200918 years) who underwent TP for pancreatic neoplasms were identified in the National Cancer Database (2008\u20132022). Kaplan\u2013Meier analysis assessed 90\u2010day survival stratified by income and insurance. Univariable and multivariable Cox proportional hazards analyses were performed. Multivariable Cox models adjusting for clinical, oncologic, and facility characteristics assessed the impact of income and insurance on postoperative survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 11\u2009321 patients, 90\u2010day mortality was 8.0%. Facility volume and Commission on Cancer designation were associated with 90\u2010day mortality (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), as were patient insurance and income (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). High\u2010volume facilities had more male, non\u2010Hispanic White, privately insured, and high\u2010income patients than low\u2010volume facilities (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Ninety\u2010day survival differed significantly between high\u2010 and lower\u2010income patients with each insurance type (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). On adjusted Cox analysis, high income was associated with better 90\u2010day survival for patients with Medicaid or no insurance (HR 0.42, <jats:italic>p<\/jats:italic>\u2009=\u20090.049) and Medicare (HR 0.77, <jats:italic>p<\/jats:italic>\u2009=\u20090.008). Ninety\u2010day mortality did not differ between high\u2010 and lower\u2010income patients with private insurance (HR 1.09, <jats:italic>p<\/jats:italic>\u2009=\u20090.597). Private insurance was associated with better 90\u2010day survival versus patients with Medicaid or no insurance among lower\u2010income patients (HR 0.57, <jats:italic>p<\/jats:italic>\u2009=\u20090.002), but not high\u2010income patients (HR 1.43, <jats:italic>p<\/jats:italic>\u2009=\u20090.413).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patient insurance and income influence 90\u2010day mortality after TP, independent of clinical and facility factors. These findings suggest that financial burdens meaningfully impact postoperative recovery following TP, highlighting the need for careful preoperative screening and planning to ensure adequate support for at\u2010risk patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.70062","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T13:28:46Z","timestamp":1754486926000},"page":"706-716","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Patient Income and Insurance on Postoperative Mortality After Total Pancreatectomy for Pancreatic Neoplasms"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5963-4513","authenticated-orcid":false,"given":"Gracia Maria","family":"Vargas","sequence":"first","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8493-6976","authenticated-orcid":false,"given":"Mohammad Saad","family":"Farooq","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neha","family":"Shafique","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Major Kenneth","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles M.","family":"Vollmer","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John T.","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgos C.","family":"Karakousis","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1245\/s10434-020-08986-6","article-title":"ASO Author Reflections: The Beneficial Effect of High\u2010Volume Center Experience on Surgical Outcomes After Total Pancreatectomy","volume":"27","author":"Stoop T. 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