Minimally Invasive Surgery is Associated with an Increased Risk of Postoperative Venous Thromboembolism After Distal Pancreatectomy.

Autor: Willobee BA; Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Dosch AR; Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Allen CJ; Division of Surgery, Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Macedo FI; Department of Surgery, Surgical Oncology, University of Central Florida College of Medicine, Orlando, FL, USA., Bartholomew TS; University of Miami Miller School of Medicine, Miami, FL, USA., Picado O; Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Gaidarski AA; Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Dudeja V; Division of Surgical Oncology, Department of Surgery, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.; Sylvester Comprehensive Cancer Center, Miami, FL, USA., Yakoub D; Department of Surgery, Surgical Oncology, University of Tennessee Health Science Center College of Medicine Memphis, Memphis, TN, USA., Merchant NB; Division of Surgical Oncology, Department of Surgery, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA. nmerchant@med.miami.edu.; Sylvester Comprehensive Cancer Center, Miami, FL, USA. nmerchant@med.miami.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2020 Jul; Vol. 27 (7), pp. 2498-2505. Date of Electronic Publication: 2020 Jan 09.
DOI: 10.1245/s10434-019-08166-1
Abstrakt: Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality following distal pancreatectomy (DP). However, the influence of operative technique on VTE risk after DP is unknown.
Objective: The purpose of this study was to examine the association between the MIS technique versus the open technique and the development of postoperative VTE after DP.
Methods: Patients who underwent DP from 2014 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program pancreas-specific database. Multivariable logistic regression was then used to identify independent associations with the development of postoperative VTE after DP.
Results: A total of 3558 patients underwent DP during this time period. Of these cases, 47.8% (n = 1702) were performed via the MIS approach. After adjusting for significant covariates, the MIS approach was independently associated with the development of any VTE (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.06-2.40; p = 0.025), as well as increasing the risk of developing a postdischarge VTE (OR 1.80, 95% CI 1.05-3.08; p = 0.033) when compared with the open approach. There was an association between VTE and the development of numerous postoperative complications, including pneumonia, unplanned intubation, need for prolonged mechanical ventilation, and cardiac arrest.
Conclusion: Compared with the open approach, the MIS approach is associated with higher rates of postoperative VTE in patients undergoing DP. The majority of these events are diagnosed after hospital discharge.
Databáze: MEDLINE
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