Risk Stratification for Distal Pancreatectomy Utilizing ACS-NSQIP: Preoperative Factors Predict Morbidity and Mortality

Kelly, Kaitlyn J.; Greenblatt, David Yü; Yin, Wei; Rettammel, Robert J.; Winslow, Emily R.; Cho, Clifford S.; Weber, Sharon M.

doi:10.1007/s11605-010-1390-9

Cited by 103 publications

(64 citation statements)

References 26 publications

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“…We applied the new American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) standard to define postoperative complications [13,14]. Surgical complications were graded according to the Clavien-Dindo classification for patients with postoperative complications (grade II or greater) [15][16][17].…”

Section: Methodsmentioning

confidence: 99%

Predictors of postoperative complications in elderly and oldest old patients with gastric cancer

et al. 2014

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Background The incidence of gastric cancer has been increasing among elderly persons in Japan. This study aimed to clarify risk factors for postoperative complications in oldest old patients with gastric cancer. Methods One-hundred ninety patients more than 75 years old with gastric cancer underwent gastrectomy between 2000 and 2011. Patients were classified into two groups: group A included 29 patients who were 85 years or older (oldest old patients), and group B included 161 patients who were 75-84 years of age. Perioperative parameters associated with complications were compared in each group. Results The preoperative estimated glomerular filtration rate was significantly lower in group A (p = 0.03). The two groups significantly differed in performance status (p = 0.018). Patients in group A received a lesser extent of lymph node dissection and had fewer lymph nodes excised. As a result, the duration of the operation was significantly shorter in group A. There were no significant differences in the frequency or grade of total complications or mortality between the two groups. Operative hemorrhage ([300 ml) and Hiroshima POSSUM (predicted morbidity risk [40) were risk factors in both groups A and B; the risk factors of preoperative serum albumin level and prognostic nutritional index (PNI) were specific to group A.Conclusions Adjustments to the extent of surgery among oldest old patients most likely reduces the incidence of postoperative complications in this group. Preoperative serum albumin level and PNI are significant predictors of postoperative complications in oldest old patients with gastric cancer.

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Section: Methodsmentioning

confidence: 99%

Predictors of postoperative complications in elderly and oldest old patients with gastric cancer

et al. 2014

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“…Patients were examined and observations charts reviewed daily by the clinical team for the presence of SIRS or infection, starting on the morning after surgery (Day 1). SIRS was defined according to international convention when two or more of the following criteria were present: 1. body temperature <36°C or >38°C; 2. heart rate >90 beats per minute; 3. tachypnoea with breathing rate >20 breaths per minute and 4. peripheral white cell count <4000 cells/mm 3 or >12,000 cells/mm. 3,14 Definitions of infection were agreed a priori by the investigators and were based on the Center for Disease Control and Prevention definitions.…”

Section: Data Collectionmentioning

confidence: 99%

“…SIRS was defined according to international convention when two or more of the following criteria were present: 1. body temperature <36°C or >38°C; 2. heart rate >90 beats per minute; 3. tachypnoea with breathing rate >20 breaths per minute and 4. peripheral white cell count <4000 cells/mm 3 or >12,000 cells/mm. 3,14 Definitions of infection were agreed a priori by the investigators and were based on the Center for Disease Control and Prevention definitions. 15 Venous blood sampling and separation Bloods were taken at clinically indicated times pre-operatively, and on day 1 and day 2 postoperatively.…”

Section: Data Collectionmentioning

confidence: 99%

“…Overall, there is a 7-fold increase in 28 day mortality in hospitalised patients with SIRS compared to those without. 2 The incidence of post-operative sepsis (SIRS plus presumed or confirmed infection) is high in major operations; 16.7% following distal pancreatic resections, 3 or 32-46% in digestive and gynaecological tumour resections. 4 Identification of patients at risk of SIRS would allow pre-emptive therapy that may improve outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Systemic Inflammatory Response Syndrome After Major Abdominal Surgery Predicted by Early Upregulation of TLR4 and TLR5

et al. 2016

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Mini AbstractPatients undergoing major surgery are at risk of life-threatening complications including systemic inflammatory response syndrome (SIRS) and sepsis. Early post-operative expression of TLR4 and TLR5 and their downstream signalling pathways in monocytes leads to over-expression of IL-6 and can predict SIRS in patients undergoing hepatopancreaticobiliary surgery. Running Title -Monocyte dysfunction in post-operative SIRS AbstractObjective To study innate immune pathways in hepatopancreaticobiliary (HPB) surgical patients to understand mechanisms leading to enhanced inflammatory responses and identifying biomarkers of adverse clinical consequences. Summary Background Data Patients undergoing major abdominal surgery are at risk of life-threatening systemic inflammatory response syndrome (SIRS) and sepsis. Early identification of at-risk patients would allow tailored post-operative care and improve survival. Methods Two separate cohorts of patients undergoing major HPB surgery were studied (combined n=69). Bloods were taken pre-operatively, on day 1 and day 2 post-operatively. Peripheral blood mononuclear cells and serum were separated and immune phenotype and function assessed ex vivo. Results Early innate immune dysfunction was evident in 12 patients who subsequently developed SIRS (post-operative day 6) compared to 27 who did not, when no clinical evidence of SIRS was apparent (pre-operatively or days 1 and 2). Serum interleukin (IL)-6 concentration and monocyte TLR/NF-DB/IL-6 functional pathways were significantly upregulated and overactive in patients who developed SIRS (p<0.0001). Interferon alpha-mediated STAT1 phosphorylation was higher pre-operatively in patients who developed SIRS. Increased TLR4 and TLR5 gene expression in whole blood was demonstrated in a separate validation cohort of 30 patients undergoing similar surgery. Expression of TLR4/5 on monocytes, particularly intermediate CD14 ++ CD16 + monocytes, on day 1 or 2 predicted SIRS with accuracy 0.89-1.0 (areas under receiver operator curves). Conclusions These data demonstrate the mechanism for IL-6 overproduction in patients who develop post-operative SIRS and identify markers that predict patients at risk of SIRS 5 days before onset of 30 patients undergoing similar surgery. Expression of TLR4/5 on monocytes, particularly intermediate CD14 ++ CD16 + monocytes, on day 1 or 2 predicted SIRS with accuracy 0.89-1.0 (areas under receiver operator curves).

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“…23 Still others, derived from the ACS-NSQIP database, blend elements of both. 24,25 While these may be effective at segregating outcomes at the population level, the real ability of these tools to forecast an actual, individual mortality is unknown.…”

Section: Introductionmentioning

confidence: 99%

A Root-Cause Analysis of Mortality Following Major Pancreatectomy

Vollmer

Sánchez

Gondek

et al. 2012

Journal of Gastrointestinal Surgery

216

110

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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.

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Risk Stratification for Distal Pancreatectomy Utilizing ACS-NSQIP: Preoperative Factors Predict Morbidity and Mortality

Cited by 103 publications

References 26 publications

Predictors of postoperative complications in elderly and oldest old patients with gastric cancer

Predictors of postoperative complications in elderly and oldest old patients with gastric cancer

Systemic Inflammatory Response Syndrome After Major Abdominal Surgery Predicted by Early Upregulation of TLR4 and TLR5

A Root-Cause Analysis of Mortality Following Major Pancreatectomy

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