A Comparison of Pancreaticoduodenectomy Outcomes Between a Safety-Net Hospital and the American College of Surgeons National Surgical Quality Improvement Program in Black/African American Patients: a Propensity Score Matched Analysis

Pather, Keouna; Hacker, Shoshana; Guerrier, Christina; Mobley, Erin M.; Esma, Rhemar; Baskovich, Brett; Parker, Alexander S.; Vigal, Kimberly; Awad, Ziad T.

doi:10.1016/j.jamcollsurg.2021.07.224

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“…Details on the postoperative care of this patient population have been previously described. [17,19] ANESTHETIC MANAGEMENT Anesthesia was administered based on the anesthesia team's discretion, with monitoring using electrocardiography, pulse oximetry, capnography, and noninvasive and invasive blood pressure measurements from the induction of anesthesia to the end of surgery. General anesthesia was induced with propofol, maintained with sevo urane (1-3 vol%), and supplemented with narcotics (fentanyl and/or hydromorphone).…”

Section: Methodsmentioning

confidence: 99%

“…[18] Despite a high case mix index for pancreas surgeries, UFHJ has consistently performed at or exceeded comparator LSCMCs across various clinical and cost outcomes, including hospital and intensive care unit length of stay, mortality, and readmission after discharge. [17,19] In this single-center retrospective cohort study, our primary objective was to investigate postoperative AKI and its association with intraoperative volume administration, vasopressor infusions, and signi cant hypotension (MAP < 55 mmHg for more than 10 minutes -cumulative). The secondary outcome was the effect of those parameters on the development of a clinically relevant postoperative pancreatic stula (CR-POPF).…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: A single center 200 patient retrospective cohort study

Lydon,

Shah,

Mongan

et al. 2024

Preprint

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BACKGROUND Pancreatic surgery is associated with a significant risk for acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). This investigation evaluated the impact of intraoperative volume administration, vasopressor therapy, and blood pressure management on the primary outcome of AKI and the secondary outcome of a CR-POPF after pancreatic surgery.METHODS This retrospective single-center cohort investigated 200 consecutive pancreatic surgeries (January 2018- December 2021). Patients were categorized for the presence/absence of AKI (Kidney Disease Improving Global Outcomes) and CR-POPF. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes.RESULTS AKI was identified in 20 patients (10%) with significant univariate differences in demographics (body mass index and gender), comorbidities, indices of chronic renal insufficiency, and an increased AKI risk score. Surgical characteristics, intraoperative fluid, vasopressor, and blood pressure management were similar in patients with and without AKI. Patients with AKI had increased blood loss, lower urine output, and packed red blood cell administration. After multivariate analysis, male gender (OR = 7.9, 95% C.I. 1.8–35.1) and the AKI risk score (OR = 6.3, 95% C.I. 24-16.4) were highly associated with the development of AKI (p < 0.001). Intraoperative and postoperative volume, vasopressor administration, and intraoperative hypotension had no significant impact in the multivariate analysis. CR-POPF occurred in 23 patients (11.9%) with no significant contributing factors in the multivariate analysis. Patients who developed AKI or a CR-POPF had an increase in surgical complications, length of stay, discharge to a skilled nursing facility, and mortality.CONCLUSION Factors such as gender and an AKI RISK score were associated with an increased likelihood of AKI. The development of AKI or a CR-POPF was associated with longer length of stay, discharge to a skilled nursing facility, or death. However, no modifiable volume, vasopressor, or blood pressure targets were identified to decrease the risk of AKI or CR-POPF.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: A single center 200 patient retrospective cohort study

Lydon,

Shah,

Mongan

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

A Comparison of Pancreaticoduodenectomy Outcomes Between a Safety-Net Hospital and the American College of Surgeons National Surgical Quality Improvement Program in Black/African American Patients: a Propensity Score Matched Analysis

Abstract: INTRODUCTION:The aim of this study was to compare 30-day adverse events after pancreaticoduodenectomy between our safety-net hospital and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in Black/ African American (AA) patients.

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Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: A single center 200 patient retrospective cohort study

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: A single center 200 patient retrospective cohort study

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