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Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death

Published on Nov 1, 2018in Journal of Surgical Research 1.87
· DOI :10.1016/j.jss.2018.05.075
Sowmya Narayanan4
Estimated H-index: 4
(UVA: University of Virginia),
Allison N. Martin4
Estimated H-index: 4
(UVA: University of Virginia)
+ 3 AuthorsVictor M. Zaydfudim10
Estimated H-index: 10
(UVA: University of Virginia)
Cite
Abstract
Abstract Background Safety of pancreaticoduodenectomy has improved significantly in the past 3 decades. Current inpatient and 30-d mortality rates are low. However, incidence and causes of 90-d and 1-y mortality are poorly defined and largely unexplored. Methods All patients who had pancreaticoduodenectomy between 2007 and 2016 were included in this single institution, retrospective cohort study. Distributions of pancreaticoduodenectomy-specific morbidity and cause-specific mortality were compared between early (within 90 d) and late (91-365 d) postoperative recovery periods. Results A total of 551 pancreaticoduodenectomies were performed during the study period. Of these, 6 (1.1%), 20 (3.6%), and 91 (16.5%) patients died within 30, 90, and 365 d after pancreaticoduodenectomy, respectively. Causes of early and late mortality varied significantly (all P  ≤ 0.032). The most common cause of death within 90 d was due to multisystem organ failure from sepsis or aspiration in 9 (45%) patients, followed by post-pancreatectomy hemorrhage in 5 (25%) patients, and cardiopulmonary arrest from myocardial infarction or pulmonary embolus in 3 (15%) patients. In contrast, recurrent cancer was the most common cause of death in 46 (65%) patients during the late postoperative period between 91 and 365 d. Mortality from failure to thrive and debility was similar between early and late postoperative periods (15% versus 19.7%, P  = 0.76). Conclusions Most quality improvement initiatives in patients selected for pancreaticoduodenectomy have focused on reduction of technical complications and improvement of early postoperative mortality. Further reduction in postoperative mortality after pancreaticoduodenectomy can be achieved by improving patient selection, mitigating postoperative malnutrition, and optimizing preoperative cancer staging and management strategies.
  • References (27)
  • Citations (1)
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References27
Newest
Published on Jan 1, 2018in Diseases of The Colon & Rectum 4.09
Vladimir Bolshinsky1
Estimated H-index: 1
,
Michael H.-G. Li1
Estimated H-index: 1
+ 3 AuthorsAlexander G. Heriot39
Estimated H-index: 39
BACKGROUND:Prehabilitation reflects a proactive process of preoperative optimization undertaken between cancer diagnosis and definitive surgical treatment, with the intent of improving physiological capacity to withstand the major insult of surgery. Prehabilitation before GI cancer surgery is curren
Published on Jan 1, 2018in Annals of Surgery 9.48
Anael Barberan-Garcia7
Estimated H-index: 7
,
M. Ubré3
Estimated H-index: 3
+ 7 AuthorsGraciela Martínez-Pallí16
Estimated H-index: 16
Objective:The aim of this study was to assess the impact of personalized prehabilitation on postoperative complications in high-risk patients undergoing elective major abdominal surgery.Summary Background Data:Prehabilitation, including endurance exercise training and promotion of physical activity,
Published on Aug 1, 2017in Ejso 3.38
Michele Mazzola3
Estimated H-index: 3
,
C. Bertoglio3
Estimated H-index: 3
+ 5 AuthorsGiovanni Carlo Ferrari15
Estimated H-index: 15
Abstract Introduction Certain surgical interventions, especially those involving upper GI tract remain challenging, due to high morbidity and mortality rates. The study of frailty in the surgical population has allowed the identification of those patients with a higher risk of poor postoperative outcomes. There remains a lack of evidence regarding the possibility of improving these results through a preoperative holistic management of the patients. The aim of this study is to evaluate whether pr...
Published on Jun 1, 2017in Digestive Diseases and Sciences 2.94
Heather Lyu8
Estimated H-index: 8
(Brigham and Women's Hospital),
Gaurav Sharma42
Estimated H-index: 42
(Brigham and Women's Hospital)
+ 5 AuthorsEdward E. Whang47
Estimated H-index: 47
(Brigham and Women's Hospital)
Background Pancreatic resection is associated with a high incidence of postoperative complications, some of which require reoperation.
Published on Jun 1, 2017in Journal of Surgical Research 1.87
Patrick R. Varley6
Estimated H-index: 6
(University of Pittsburgh),
David A. Geller66
Estimated H-index: 66
(University of Pittsburgh),
Allan Tsung51
Estimated H-index: 51
(University of Pittsburgh)
Abstract Background Failure to rescue is the concept of death after a complication, and it is an important factor driving variation in mortality rates after pancreatic surgery. The purpose of this study was to conduct a retrospective review of a large, multi-institutional data set to describe patient-level risk factors for failure to rescue in greater detail. Methods From the American College of Surgeons National Surgical Quality Improvement Program participant use file, 14,557 patients who unde...
Published on May 1, 2017in Annals of Surgery 9.48
Ibrahim Nassour7
Estimated H-index: 7
(UTSW: University of Texas Southwestern Medical Center),
Sam C. Wang13
Estimated H-index: 13
+ 8 AuthorsPatricio M. Polanco12
Estimated H-index: 12
To compare the perioperative outcomes of minimally invasive pancreaticoduodenectomy (MIPD) in comparison with open pancreaticoduodenectomy (OPD) in a national cohort of patients. Limited well-controlled studies exist comparing perioperative outcomes between MIPD and OPD. Patients who underwent MIPD and OPD were abstracted from the 2014 to 2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program. OPD and MIPD patients were matched 3:1 using propensity scor...
Published on May 1, 2017in Annals of Surgery 9.48
Matthew T. McMillan15
Estimated H-index: 15
(UPenn: University of Pennsylvania),
Valentina Allegrini7
Estimated H-index: 7
+ 32 AuthorsMark P. Callery46
Estimated H-index: 46
Objective:This multicenter study sought to evaluate the accuracy of the American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) surgical risk calculator for predicting outcomes after pancreatoduodenectomy (PD) and to determine whether incorporating other factors impr
Published on Mar 1, 2017in Surgery 3.48
Claudio Bassi79
Estimated H-index: 79
,
Giovanni Marchegiani17
Estimated H-index: 17
+ 30 AuthorsMarc G. Besselink33
Estimated H-index: 33
(UvA: University of Amsterdam)
Background: In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of t...
Published on Nov 1, 2016in Surgery 3.48
Elizabeth M. Gleeson3
Estimated H-index: 3
(Drexel University),
Mohammad F. Shaikh4
Estimated H-index: 4
(Drexel University)
+ 4 AuthorsWilbur B. Bowne21
Estimated H-index: 21
(Drexel University)
Background Pancreaticoduodenectomy needs simple, validated risk models to better identify 30-day mortality. The goal of this study is to develop a simple risk score to predict 30-day mortality after pancreaticoduodenectomy. Methods We reviewed cases of pancreaticoduodenectomy from 2005–2012 in the American College of Surgeons-National Surgical Quality Improvement Program databases. Logistic regression was used to identify preoperative risk factors for morbidity and mortality from a development c...
Published on Feb 16, 2016in Cochrane Database of Systematic Reviews 7.75
Felix J. Hüttner9
Estimated H-index: 9
(Heidelberg University),
Christina Fitzmaurice28
Estimated H-index: 28
(Fred Hutchinson Cancer Research Center)
+ 4 AuthorsMarkus K. Diener31
Estimated H-index: 31
(Heidelberg University)
Background Pancreatic cancer is the fourth-leading cause of cancer death for both, men and women. The standard treatment for resectable tumours consists of a classic Whipple (CW) operation or a pylorus-preserving pancreaticoduodenectomy (PPW). It is unclear which of these procedures is more favourable in terms of survival, postoperative mortality, complications, and quality of life. Objectives The objective of this systematic review was to compare the effectiveness of CW and PPW techniques for s...
Cited By1
Newest
Walid Faraj12
Estimated H-index: 12
(AUB: American University of Beirut),
Hussein Nassar2
Estimated H-index: 2
(AUB: American University of Beirut)
+ 5 AuthorsMohamad Khalife5
Estimated H-index: 5
(AUB: American University of Beirut)
Abstract Background Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri‑ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015. Methods We performed a retrospective review of the medical charts of patients who underwent pancreaticoduodenectomy at our institution. Data wa...