Assessment of risk factors for complications after pancreatic surgery

Abstract

Introduction: Mortality rates after pancreaticoduodenectomy have decreased dramatically during the last two decades in high volume centers. However, despite a low mortality rate and improvements in perioperative care, morbidity rate is still high after pancreaticoduodenectomy. Studies defining the role of potential risk factors for the development of postoperative complications are few, and sometimes with conflicting results. There is need to identify potential risk factors for predicting complications after pancreatic resections. Aim: The aim of the present study was to assess the risk factors for morbidity after pancreatic resections, by utilizing a simple grading system and identify the factors affecting them. Material and Methods: This was a prospective study done in the Department of Surgical Gastroenterology between Feb 2007 to Jun 2009. All patients who underwent elective pancreatic surgeries were included in this study. Major Morbidity was defined as patients having grade III and above complications. The risk factors assessed were patient factors, disease factors, operative factors and postoperative factors. Risk factors were analyzed for morbidity and major morbidity separately. Results: One Hundred and Seven patients underwent elective pancreatic surgeries between Feb 2007 to Jun 2009. Pancreaticoduodenectomy was the commonest procedure. Three patients died after pancreatic surgeries. Mortality rate after pancreatic surgery was 2.8% (3/107) and that after Whipple's procedure was 4.68% (3/64).In our study a total of 58 of 107 (54.2%) patients developed complications after pancreatic surgery. Major morbidity defined as Grade III or more complication was seen in 24.2% (26/107). Complications after Whipple's procedure was seen in 49 of 64 (76%) patients. Major morbidity (Grade III and more) was seen in 22 of 64 patients (34.3%). All complications following pancreatic surgeries were graded. The mean postoperative duration was 12.4 days (6 -47 days).The significant risk factors for morbidity after pancreatic surgery were soft pancreas (OR 5.988; p=.007), SGPT > 73 U/L (OR 3.623; p = .054), age > 50yrs (OR 3.254; p = .053), and absence of chronic pancreatitis (OR 4.363, p = .016).The significant factors for major morbidity were soft pancreas (OR 6.557, p = .005), hypertension (OR 5.803, p = .037) and BMI >25(OR 4.052, p = .05). Conclusions 1. Independent factors predicting morbidity after pancreatic surgery were soft pancreas, age > 50yrs, SGPT > 73 U/L and absence of chronic pancreatitis. 2. Independent factors predicting major morbidity after pancreatic surgery were soft pancreas, hypertension and BMI > 25.

Perioperative Risk Factors & Outcome After Pancreatico-Duodenectomy (Whipple Procedure)

“…Although the Whipple operation is considered one of the most challenging abdominal operations, it remains the only curative option for periampullary malignancy. 31 In this study, developing postoperative morbidity was not statistically significant in association with sex distribution (Pvalue = 0.82), which is similar to a study done in India by Prasad et al 32 Regarding age, this study showed that there is significant association between increased age and developing postoperative morbidity (P-value = 0.03), which is similar to a study done by Haigh et al 33 The presence of preoperative co-morbidities, be it hypertension, diabetes, cardiac and pulmonary diseases or a history of smoking, were associated with significant morbidity in this study (P-value = 0.0001), which is similar to a study done in India by Madhav et al 14 The site of the tumor (pancreatic, duodenal, ampullary or distal common bile duct) had no significant association with developing postoperative morbidity (P-value = 0.38), which is similar to a study done by House et al 34 Tumor differentiation was not significantly associated with postoperative morbidity (Pvalue = 0.35), in contrast to a study done by Ajith Prasad et al, where there was a significant difference in postoperative morbidity with poorly differentiated tumors. 32 Lymph nodes involvement by histopathological report was not associated with postoperative morbidity (Pvalue = 0.14), which is similar to a study done by Yeo et al 35 The most common postoperative complications in this study were pancreatic leakage (15.9%), superficial surgical site infection (13.6%) and pulmonary embolism (11.3%), which is similar to a study done by Greenblatt et al, 36 whose frequencies of the above complications were 15.3%, 13.1% and 9.5%, respectively.…”

“…8 Also, despite the decrease in mortality in the last two decades, morbidity is still high. 14 The mortality rate in high volume centers (where individual surgeons perform more than 15 cases yearly) is about 5%. 15 Many important variables contribute to the outcome of this operation, based on patient's general health, experience of surgeons and the volume of complex operations done by the surgeon.…”