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Preoperative Factors Predict Perioperative Morbidity and Mortality After Pancreaticoduodenectomy

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pancreaticoduodenectomy (PD) has long been associated with high rates of morbidity and mortality. The objective of this study was to identify preoperative risk factors for serious complications and mortality after PD and to construct a prediction tool to facilitate risk stratification prior to surgery.

Materials and Methods

Patients who underwent elective PD from 2005 to 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Multivariate logistic regression identified predictors of 30-day serious complications and mortality. A prediction tool was created and validated in a sample of 1254 patients.

Results

Of 4945 patients who underwent PD, 1342 (27.1%) suffered a serious complication and 127 (2.6%) died within 30 days. The most frequent complications were sepsis (15.3%), surgical site infection (13.1%), and respiratory complications (9.5%). After adjusting for potential confounders, the significant predictors of morbidity included older age, male gender, overweight and obesity, dependent functional status, chronic obstructive pulmonary disease (COPD), steroid use, bleeding disorder, leukocytosis, elevated serum creatinine, and hypoalbuminemia. Significant predictors of 30-day mortality included COPD, hypertension, neoadjuvant radiation therapy, elevated serum creatinine, and hypoalbuminemia. Multivariable models were used to construct a preoperative risk stratification tool.

Conclusions

Preoperative factors are associated with perioperative outcomes after PD. The prediction tool estimates the probability of early morbidity and mortality for patients undergoing PD. The tool may be used to provide information for patient counseling during the informed consent process and to identify high-risk patients for the purpose of tailoring perioperative care.

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin, Madison, WI, USA

    David Yu Greenblatt MD, MSPH, Kaitlyn J. Kelly MD, Victoria Rajamanickam MS, Yin Wan MS, Todd Hanson BS, Robert Rettammel MA, Emily R. Winslow MD, Clifford S. Cho MD, FACS & Sharon M. Weber MD, FACS

Authors
  1. David Yu Greenblatt MD, MSPH
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  2. Kaitlyn J. Kelly MD
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  3. Victoria Rajamanickam MS
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  4. Yin Wan MS
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  5. Todd Hanson BS
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  6. Robert Rettammel MA
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  7. Emily R. Winslow MD
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  8. Clifford S. Cho MD, FACS
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  9. Sharon M. Weber MD, FACS
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Corresponding author

Correspondence to David Yu Greenblatt MD, MSPH.

Additional information

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in it represent the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or for the conclusions derived by the authors.

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Greenblatt, D.Y., Kelly, K.J., Rajamanickam, V. et al. Preoperative Factors Predict Perioperative Morbidity and Mortality After Pancreaticoduodenectomy. Ann Surg Oncol 18, 2126–2135 (2011). https://doi.org/10.1245/s10434-011-1594-6

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  • DOI: https://doi.org/10.1245/s10434-011-1594-6

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