Factors Predictive of Reoperation After Pancreaticoduodenectomy for Pancreatic Cancer

Bradley R. Hall, Richard Sleightholm, Lynette M Smith, Harlan Sayles, Chandrakanth Are

Research output: Contribution to journalArticle

Abstract

While mortality is low, morbidity remains high for patients undergoing pancreas resections, especially for those who return to the operating room (RTOR). The aim of this study is to identify risk factors for RTOR following pancreaticoduodenectomy (PD) for ductal adenocarcinoma. Logistic regression models were constructed using the 2014 and 2015 National Surgical Quality Improvement Program (NSQIP) Pancreas Targeted database. Preoperative and procedure-related risk factors predictive of RTOR for patients undergoing either classic or pylorus-preserving pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) were identified. A total of 1736 patients were included. Multivariable analysis of patients undergoing classic PD demonstrated that an abnormally low preoperative WBC count was significantly associated with RTOR (OR 2.78, 95% CI 1.27–6.06, p = 0.010). For patients who underwent pylorus-preserving PD, the wound classification (OR 3.99, 95% CI 1.75–9.11, p = 0.001) and arterial resection (OR 26.3, 95% CI 7.96–87.20, p < 0.001) were associated with a higher rate of RTOR. When analyzing both approaches (classic and pylorus-preserving PD) together, only isolated arterial (OR 9.98, 95% CI 3.81–26.18, p < 0.001) and isolated venous (OR 1.79, 95% CI 1.05–3.05, p = 0.032) resections were independently associated with RTOR. The results of our study demonstrate that few factors are predictive of RTOR. Knowledge of these few variables in combination with a focus on the components of medical care in the immediate postoperative period may help identify individuals at risk for RTOR and improve patient care.

Original languageEnglish (US)
JournalIndian Journal of Surgical Oncology
DOIs
StatePublished - Jan 1 2019

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Pancreaticoduodenectomy
Operating Rooms
Pancreatic Neoplasms
Reoperation
Pylorus
Pancreas
Adenocarcinoma
Logistic Models
Preoperative Care
Quality Improvement
Postoperative Period
Patient Care
Databases
Morbidity
Mortality
Wounds and Injuries

Keywords

  • Morbidity
  • Mortality
  • Pancreatic cancer
  • Reoperation

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Factors Predictive of Reoperation After Pancreaticoduodenectomy for Pancreatic Cancer. / Hall, Bradley R.; Sleightholm, Richard; Smith, Lynette M; Sayles, Harlan; Are, Chandrakanth.

In: Indian Journal of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "While mortality is low, morbidity remains high for patients undergoing pancreas resections, especially for those who return to the operating room (RTOR). The aim of this study is to identify risk factors for RTOR following pancreaticoduodenectomy (PD) for ductal adenocarcinoma. Logistic regression models were constructed using the 2014 and 2015 National Surgical Quality Improvement Program (NSQIP) Pancreas Targeted database. Preoperative and procedure-related risk factors predictive of RTOR for patients undergoing either classic or pylorus-preserving pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) were identified. A total of 1736 patients were included. Multivariable analysis of patients undergoing classic PD demonstrated that an abnormally low preoperative WBC count was significantly associated with RTOR (OR 2.78, 95{\%} CI 1.27–6.06, p = 0.010). For patients who underwent pylorus-preserving PD, the wound classification (OR 3.99, 95{\%} CI 1.75–9.11, p = 0.001) and arterial resection (OR 26.3, 95{\%} CI 7.96–87.20, p < 0.001) were associated with a higher rate of RTOR. When analyzing both approaches (classic and pylorus-preserving PD) together, only isolated arterial (OR 9.98, 95{\%} CI 3.81–26.18, p < 0.001) and isolated venous (OR 1.79, 95{\%} CI 1.05–3.05, p = 0.032) resections were independently associated with RTOR. The results of our study demonstrate that few factors are predictive of RTOR. Knowledge of these few variables in combination with a focus on the components of medical care in the immediate postoperative period may help identify individuals at risk for RTOR and improve patient care.",
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