Surgery for chronic pancreatitis can achieve a textbook outcome in 74.1% of patients, but certain factors increase the risk of failure.

• Major complications occurred in 10% of patients, with a 1% in-hospital mortality rate.
• Prior endoscopic therapy and perioperative blood transfusion significantly increased odds of failing to achieve a textbook outcome (OR 2.1 and 2.6, respectively).
• Female patients had better outcomes (OR 0.46) suggesting a possible sex-based risk factor.

Minimizing blood transfusions and limiting endoscopic interventions preoperatively may improve outcomes.