A Root-Cause Analysis of Mortality Following Major Pancreatectomy

Abstract

Root-cause analysis suggests that risk prediction should include, if not emphasize, operative factors related to pancreatectomy. While risk models can distinguish between mortalities and nonmortalities in a collective fashion, they vastly miscalculate the actual chance of death on an individual basis. This study reveals the contributions of both comorbidities and aggressive surgical decisions to mortality.

Role of C-Reactive Protein Assessment as Early Predictor of Surgical Site Infections Development after Pancreaticoduodenectomy

“…CRP has been often considered in high grade POPF prediction models, even if it is a nonspecific marker of systemic inflammation. For this reason, it should be considered more largely suggestive for the development of serious complications with a septic base, essentially SSIs, since these represent the great majority of septic processes occurring after PD, as reported in literature [1,2,3,9] and confirmed in our series.…”

“…Pancreatic surgery is notoriously challenging and still associated with high morbidity, even in high volume surgical settings [1,2,3]. As pancreaticoduodenectomy (PD) is widely considered one of the most complex procedures in general surgery, several authors suggest that it should be performed in referral centers [4,5], where the pancreatic surgeon's technical skills are complemented by a dedicated multidisciplinary team, necessarily including anesthesiologist, endoscopist, interventional radiologist and infectious disease specialist.…”

“…In detail, surgical site infections (SSIs) [8], further divided into ‘superficial', ‘deep' and ‘organ-space' according to the specific anatomic involvement, are common in pancreatic surgery [9,10] and, with regard to organ-space SSIs, mainly depend on postoperative pancreatic fistula (POPF); this complication represents the notorious ‘Achilles heel' of pancreatic surgery, occurring with a rate ranging from 10 to 60% and remaining, even in tertiary centers, the main risk factor for postoperative mortality and increase in costs and length of hospital stay [6,11,12,13,14]. Among organ-space SSIs, biliary fistula, duodeno-jejunum anastomosis fistula, amylase-negative intra-abdominal fluid collection, pancreatic stump pancreatitis and other septic abdominal complications are relatively less frequent, as described in large series [1,2,3]. …”

An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions

“…It is often the inciting event for many downstream complications that result in longer lengths of stay, need for reinterventions, readmissions and delays in the administration of adjuvant therapy [18][19][20][21]. We sought to illicit the factors behind POPF after RPD in an attempt to identify whether some of these were unique to the robotic platform.…”

Surveillance of Cystic Lesions of the Pancreas: Whom and How to Survey

“…These PCN change over time in 44% of cases, presenting an overall rate of progression towards PC of 1%. Even if the overall risk of progression is low, and even lower if compared to the risk of postoperative death associated with major pancreatic resection [27], the observed rate of cancer at 5 years in the group of stable and indolent PCN was 31.3 per 100,000, i.e. sensibly higher if compared to the age-adjusted incidence rate of 7.04 per 100,000.…”