Khalid, Abdullah, Amini, Neda, Pasha, Shamsher A, Demyan, Lyudmyla, Newman, Elliot, King, Daniel A, DePeralta, Danielle, Gholami, Sepideh, Deutsch, Gary B, Melis, Marcovalerio, Weiss, Matthew J (May 2024) Impact of Postoperative Pancreatic Fistula on Outcomes in Pancreatoduodenectomy: A Comprehensive Analysis of ACS-NSQIP Data. Journal of Gastrointestinal Surgery. S1091-255X(24)00483. ISSN 1091-255X
Abstract
INTRODUCTION: Pancreatoduodenectomy (PD) is a major surgical procedure associated with significant risks, particularly postoperative pancreatic fistula (POPF). Studies have highlighted the importance of certain risk factors for POPF, which are vital for surgical decision-making and the management of high-risk PD patients. We aimed to assess the surgical outcomes of patients undergoing PD who met the International Study Group of Pancreatic Surgery - class D (ISGPS-D) criteria. METHODS: This study analyzed ACS-NSQIP data (2014-2021) for patients undergoing ISGPS-D PD, classified as having a soft pancreatic texture and a pancreatic duct ≤3mm. We focused on mortality rates and the correlation between several factors and POPF (ISGPS grade B/C). RESULTS: From 5,964 PD patients who met ISGPS-D criteria, the 30-day mortality rate was 1.98%. Males had a higher incidence of POPF (57.42% vs. 47.35%, p<0.001). Patients with POPF experienced significantly higher rates of major postoperative complications (Clavien-Dindo grade ≥IIIa), including thrombosis, pneumonia, sepsis, delayed gastric emptying, wound disruption, infections, and acute renal failure. There was a marked increase in the 30-day readmission and mortality rates in patients with POPF (30.0% vs. 17.6% and 3.2% vs. 1.4%, respectively; all p<0.001). Multivariate analysis highlighted female sex as a protective factor against mortality (OR 0.47, p<0.001) and extended hospital stay (>10 days) as a predictor of increased mortality risk (OR 2.37, p<0.001). CONCLUSION: This study underscores the significant association between POPF and increased postoperative morbidity and mortality rates. Future efforts should concentrate on refining surgical techniques and improving preoperative assessments to mitigate the risks associated with POPF in patients with PD.
| Item Type: | Paper |
|---|---|
| Subjects: | diseases & disorders > cancer diseases & disorders diseases & disorders > cancer > cancer types > pancreatic cancer diseases & disorders > cancer > cancer types |
| CSHL Authors: | |
| Communities: | CSHL labs > Gholami Lab |
| SWORD Depositor: | CSHL Elements |
| Depositing User: | CSHL Elements |
| Date: | 29 May 2024 |
| Date Deposited: | 12 Jun 2024 18:48 |
| Last Modified: | 12 Jun 2024 18:48 |
| Related URLs: | |
| URI: | https://repository.cshl.edu/id/eprint/41580 |
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