Einzeltreffer — DigiBib

Objective: To quantify the impact of individual complications on mortality, organ failure, hospital stay, and readmission after pancreatoduodenectomy.

Summary of Background Data: An initial complication may provoke a sequence of adverse events potentially leading to mortality after pancreatoduodenectomy. This study was conducted to aid prioritization of quality improvement initiatives.

Methods: Data from consecutive patients undergoing pancreatoduodenectomy (2014-2017) were extracted from the Dutch Pancreatic Cancer Audit. Population attributable fractions (PAF) were calculated for the association of each complication (ie, postoperative pancreatic fistula, postpancreatectomy hemorrhage, bile leakage, delayed gastric emptying, wound infection, and pneumonia) with each unfavorable outcome [ie, in-hospital mortality, organ failure, prolonged hospital stay (>75th percentile), and unplanned readmission), whereas adjusting for confounders and other complications. The PAF represents the proportion of an outcome that could be prevented if a complication would be eliminated completely.

Results: Overall, 2620 patients were analyzed. In-hospital mortality occurred in 95 patients (3.6%), organ failure in 198 patients (7.6%), and readmission in 427 patients (16.2%). Postoperative pancreatic fistula and postpancreatectomy hemorrhage had the greatest independent impact on mortality [PAF 25.7% (95% CI 13.4-37.9) and 32.8% (21.9-43.8), respectively] and organ failure [PAF 21.8% (95% CI 12.9-30.6) and 22.1% (15.0-29.1), respectively]. Delayed gastric emptying had the greatest independent impact on prolonged hospital stay [PAF 27.6% (95% CI 23.5-31.8)]. The impact of individual complications on unplanned readmission was smaller than 11%.

Conclusion: Interventions focusing on postoperative pancreatic fistula and postpancreatectomy hemorrhage may have the greatest impact on in-hospital mortality and organ failure. To prevent prolonged hospital stay, initiatives should in addition focus on delayed gastric emptying.

Competing Interests: The author reports no conflicts of interest.

Titel:	Impact of Complications After Pancreatoduodenectomy on Mortality, Organ Failure, Hospital Stay, and Readmission: Analysis of a Nationwide Audit.
Autor/in / Beteiligte Person:	Smits, FJ ; Verweij, ME ; Daamen, LA ; van Werkhoven CH ; Goense, L ; Besselink, MG ; Bonsing, BA ; Busch, OR ; van Dam RM ; van Eijck CHJ ; Festen, S ; Koerkamp, BG ; van der Harst E ; de Hingh IH ; Kazemier, G ; Klaase, JM ; van der Kolk M ; Liem, M ; Luyer, MDP ; Meerdink, M ; Mieog, JSD ; Nieuwenhuijs, VB ; Roos, D ; Schreinemakers, JM ; Stommel, MW ; Wit, F ; Zonderhuis, BM ; de Meijer VE ; van Santvoort HC ; Molenaar, IQ
Link:	Full Text Finder (Volltext)
Zeitschrift:	Annals of surgery, Jg. 275 (2022), Heft 1, S. e222-e228
Veröffentlichung:	Philadelphia, PA : Lippincott Williams & Wilkins, 2022
Medientyp:	academicJournal
ISSN:	1528-1140 (electronic)
DOI:	10.1097/SLA.0000000000003835
Schlagwort:	Aged Female Follow-Up Studies Hospital Mortality trends Humans Incidence Length of Stay Male Middle Aged Netherlands epidemiology Pancreatic Neoplasms diagnosis Pancreatic Neoplasms mortality Patient Readmission trends Retrospective Studies Risk Factors Survival Rate trends Pancreatic Neoplasms surgery Pancreaticoduodenectomy adverse effects Postoperative Complications epidemiology
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Corporate Authors: Dutch Pancreatic Cancer Group Publication Type: Journal Article; Multicenter Study Language: English [Ann Surg] 2022 Jan 01; Vol. 275 (1), pp. e222-e228. MeSH Terms: Pancreatic Neoplasms / surgery ; Pancreaticoduodenectomy / adverse effects ; Postoperative Complications / *epidemiology ; Aged ; Female ; Follow-Up Studies ; Hospital Mortality / trends ; Humans ; Incidence ; Length of Stay ; Male ; Middle Aged ; Netherlands / epidemiology ; Pancreatic Neoplasms / diagnosis ; Pancreatic Neoplasms / mortality ; Patient Readmission / trends ; Retrospective Studies ; Risk Factors ; Survival Rate / trends References: Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017; 389:1011–1024. ; Neoptolemos JP, Moore MJ, Cox TF, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma. JAMA 2012; 308:147. ; Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer. JAMA 2013; 310:1473–1481. ; Pugalenthi A, Protic M, Gonen M, et al. Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol 2016; 113:188–193. ; Okano K, Hirao T, Unno M, et al. Postoperative infectious complications after pancreatic resection. Br J Surg 2015; 102:1551–1560. ; Harnoss JCJM, Ulrich AB, Harnoss JCJM, et al. Use and results of consensus definitions in pancreatic surgery: a systematic review. Surgery 2014; 155:47–57. ; Santema TB, Visser A, Busch ORC, et al. Hospital costs of complications after a pancreatoduodenectomy. HPB (Oxford) 2015; 17:723–731. ; Pulvirenti A, Marchegiani G, Pea A, et al. Clinical implications of the 2016 international study group on pancreatic surgery definition and grading of postoperative pancreatic fistula on 775 consecutive pancreatic resections. Ann Surg 2018; 268:1069–1075. ; DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery. Ann Surg 2006; 244:931–939. ; Smits FJ, van Santvoort HC, Besselink MG, et al. Management of severe pancreatic fistula after pancreatoduodenectomy. JAMA Surg 2017; 152:540–548. ; Hata T, Motoi F, Ishida M, et al. Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy. Ann Surg 2016; 263:664–672. ; DOLL R, HILL AB. A study of the aetiology of carcinoma of the lung. Br Med J 1952; 2:1271–1286. ; Ali M. Population attributable fraction. BMJ 2018; 360:k757. ; Poole C. A history of the population attributable fraction and related measures. Ann Epidemiol 2015; 25:147–154. ; Scarborough JE, Schumacher J, Pappas TN, et al. Which complications matter most? Prioritizing quality improvement in emergency general surgery. J Am Coll Surg 2016; 222:515–524. ; McCoy CC, Englum BR, Keenan JE, et al. Impact of specific postoperative complications on the outcomes of emergency general surgery patients. J Trauma Acute Care Surg 2015; 78:912–918. ; Bennett KM, Kent KC, Schumacher J, et al. Targeting the most important complications in vascular surgery. J Vasc Surg 2017; 65:793–803. ; Scarborough JE, Schumacher J, Kent KC, et al. Associations of specific postoperative complications with outcomes after elective colon resection. JAMA Surg 2017; 152:e164681. ; Goense L, Meziani J, Ruurda JP, et al. Impact of postoperative complications on outcomes after oesophagectomy for cancer. Br J Surg 2019; 106:111–119. ; van Rijssen LB, Koerkamp BG, Zwart MJ, et al. Nationwide prospective audit of pancreatic surgery: design, accuracy, and outcomes of the Dutch Pancreatic Cancer Audit. HPB 2017; 19:919–926. ; von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014; 12:1495–1499. ; Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017; 161:584–591. ; Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142:761–768. ; Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH) – an international study group of pancreatic surgery (ISGPS) definition. Surgery 2007; 142:20–25. ; Besselink MG, van Rijssen LB, Bassi C, et al. Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 2017; 161:365–372. ; Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011; 149:680–688. ; Textor J, van der Zander B, Gilthorpe MS, et al. Robust causal inference using directed acyclic graphs: the R package “dagitty”. Int J Epidemiol 2016; 45:1887–1894. ; Greenblatt DY, Kelly KJ, Rajamanickam V, et al. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 2011; 18:2126–2135. ; van der Geest LGM, van Rijssen LB, Molenaar IQ, et al. Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB (Oxford) 2016; 18:317–324. ; Nagle RT, Leiby BE, Lavu H, et al. Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy. Surg (United States) 2017; 161:959–967. ; Sugiura T, Uesaka K, Ohmagari N, et al. Risk factor of surgical site infection after pancreaticoduodenectomy. World J Surg 2012; 36:2888–2894. ; Pratt WB, Maithel SK, Vanounou T, et al. Clinical and economic validation of the international study group of pancreatic fistula (ISGPF) classification scheme. Ann Surg 2007; 245:443–451. ; Moons KGM, Donders RART, Stijnen T, et al. Using the outcome for imputation of missing predictor values was preferred. J Clin Epidemiol 2006; 59:1092–1101. ; Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159:702–706. ; Spiegelman D, Hertzmark E, Wand HC. Point and interval estimates of partial population attributable risks in cohort studies: examples and software. Cancer Causes Control 2007; 18:571–579. ; Merath K, Chen Q, Bagante F, et al. Textbook outcomes among medicare patients undergoing hepatopancreatic surgery. Ann Surg 2018; doi: 10.1097/SLA.0000000000003105. (PMID: 10.1097/SLA.0000000000003105) ; Lévesque LE, Hanley JA, Kezouh A, et al. Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes. BMJ 2010; 340:b5087. ; Wolk S, Grützmann R, Rahbari NN, et al. Management of clinically relevant postpancreatectomy hemorrhage (PPH) over two decades – a comparative study of 1 450 consecutive patients undergoing pancreatic resection. Pancreatology 2017; 17:943–950. ; Yekebas EF, Wolfram L, Cataldegirmen G, et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 2007; 246:269–280. ; Floortje van Oosten A, Smits FJ, van den Heuvel DAF, et al. Diagnosis and management of postpancreatectomy hemorrhage: a systematic review and meta-analysis. HPB (Oxford) 2019; 21:953–961. ; de Castro SMM, Busch ORC, van Gulik TM, et al. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg 2005; 92:1117–1123. ; Fuks D, Piessen G, Huet E, et al. Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg 2009; 197:702–709. ; McMillan MT, Vollmer CM, Asbun HJ, et al. The characterization and prediction of ISGPF grade c fistulas following pancreatoduodenectomy. J Gastrointest Surg 2015; 20:262–276. ; Radomski M, Zenati M, Novak S, et al. Factors associated with prolonged hospitalization in patients undergoing pancreatoduodenectomy. Am J Surg 2018; 215:636–642. ; Mazmudar A, Castle J, Yang AD, et al. The association of length of hospital stay with readmission after elective pancreatic resection. J Surg Oncol 2018; 118:7–14. ; Weber, AFF-TC-FCWA, Fernandes-Taylor S, et al. 30-day readmission after pancreatic resection. Ann Surg 2017; 266:242–250. ; Mackay TM, Smits FJ, Roos D, et al. The risk of not receiving adjuvant chemotherapy after resection of pancreatic ductal adenocarcinoma: a nationwide analysis. HPB (Oxford) 2019; S1365-182X(19)30610-0. doi:10.1016/j.hpb.2019.06.019. (PMID: 10.1016/j.hpb.2019.06.019) ; Smits FJ, van Santvoort HC, Besselink MGH, et al. Systematic review on the use of matrix-bound sealants in pancreatic resection. HPB (Oxford) 2015; 17:1033–1039. ; Allen PJ, Gönen M, Brennan MF, et al. Pasireotide for postoperative pancreatic fistula. N Engl J Med 2014; 370:2014–2022. ; Daamen LA, Smits FJ, Besselink MG, et al. A web-based overview, systematic review and meta-analysis of pancreatic anastomosis techniques following pancreatoduodenectomy. HPB 2018; 20:777–785. ; Sohn TA, Yeo CJ, Cameron JL, et al. Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 2003; 7:209–219. Entry Date(s): Date Created: 20200606 Date Completed: 20220121 Latest Revision: 20220121 Update Code: 20240513

Klicken Sie ein Format an und speichern Sie dann die Daten oder geben Sie eine Empfänger-Adresse ein und lassen Sie sich per Email zusenden.

BibTeX Citavi, JabRef, u.a.
(Literaturverwaltung)

PDF kein Volltext!
(Merkzettel, Notizen)

RIS Endnote, Citavi u.a.
(Literaturverwaltung)

MODS
(XML zur Weiterverarbeitung)

oder

Wählen Sie das für Sie passende Zitationsformat und kopieren Sie es dann in die Zwischenablage, lassen es sich per Mail zusenden oder speichern es als PDF-Datei.

Gewünschter Zitations-Stil:

oder

Bitte prüfen Sie, ob die Zitation formal korrekt ist, bevor Sie sie in einer Arbeit verwenden. Benutzen Sie gegebenenfalls den "Exportieren"-Dialog, wenn Sie ein Literaturverwaltungsprogramm verwenden und die Zitat-Angaben selbst formatieren wollen.

Impact of Complications After Pancreatoduodenectomy on Mortality, Organ Failure, Hospital Stay, and Readmission: Analysis of a Nationwide Audit.