Analysis of Risk Factors for Hemorrhage and Related Outcome After Pancreatoduodenectomy in an Intermediate-volume Center

Overview

Journal Updates Surg

Specialty General Surgery

Date 2019 Aug 4

PMID 31376077

Citations 11

Authors

Fabio Uggeri

Luca Nespoli

Marta Sandini

Anita Andreano

Luca Degrate

Fabrizio Romano

Laura Antolini

Luca Gianotti

Affiliations

Soon will be listed here.

Abstract

Precise risk factors for bleeding after pancreatoduodenectomy (PD) need to be further explored. We aimed to identify which variables were associated with the risk of post-pancreatectomy hemorrhage (PPH) and benchmark the PPH rate and related outcome in our intermediate-volume center with the current literature. We retrospectively analyzed 183 PD records. We investigated the association between PPH and a number of pre-surgical (age, body mass index, bilirubin plasma level, gender, American Society of Anesthesiologists classification (ASA) and smoking status, vascular hypertension), surgical (technique, additional organ resection, occlusion of the stump) and post-surgical (pancreatic fistula, bile leak and abscess development) risk factors with multivariable regression models. PPH episodes were classified and graded according to the International Study Group of Pancreatic Surgery. The overall PPH risk was 19.6%. Specific PPH mortality was 16.6%. Occurrence of PPH was increased in male patients (RR = 2.4, p = 0.001), with ASA ≥ 3 (RR = 2.1, p = 0.009) and hypertension (RR = 1.8, p = 0.04). Active smoking was protective (RR = 0.26, p = 0.001). Among postoperative factors, only pancreatic fistula increased the risk (RR = 1.6, p = 0.034). Early PPH was associated with the type of surgical reconstruction (RR 4.02, 95% CI 1.41-11.44, p = 0.009) and late PPH with pancreatic fistula (RR 2.88, 95% CI 1.06-7.83, p = 0.038). For grade C PPH, the impact of pancreatic fistula was greater (RR = 2.8, p = 0.04). Pancreatic fistula plays a crucial role in the pathogenesis of PPH. In addition, male gender, ASA ≥ 3 and hypertension increase the risk of PPH, while smoking appears protective. The PPH risk and subsequent consequences are at an acceptable rate in an intermediate-volume center.

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