Impact of Complications After Pancreatoduodenectomy on Mortality, Organ Failure, Hospital Stay, and Readmission: Analysis of a Nationwide Audit.

Autor:	Smits FJ; Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht and St Antonius Hospital Nieuwegein, Utrecht, The Netherlands., Verweij ME; Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht and St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.; Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Daamen LA; Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht and St Antonius Hospital Nieuwegein, Utrecht, The Netherlands., van Werkhoven CH; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Goense L; Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht and St Antonius Hospital Nieuwegein, Utrecht, The Netherlands., Besselink MG; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands., Bonsing BA; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Busch OR; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands., van Dam RM; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands., van Eijck CHJ; Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Festen S; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Koerkamp BG; Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., van der Harst E; Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands., de Hingh IH; Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands., Kazemier G; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands., Klaase JM; Department of Surgery, Radboud, University Medical Center, Nijmegen, The Netherlands., van der Kolk M; Department of Surgery, Radboud, University Medical Center, Nijmegen, The Netherlands., Liem M; Department of Surgery, Radboud, University Medical Center, Nijmegen, The Netherlands., Luyer MDP; Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands., Meerdink M; Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Mieog JSD; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Nieuwenhuijs VB; Department of Surgery, Isala, Zwolle, The Netherlands., Roos D; Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands., Schreinemakers JM; Department of Surgery, Amphia Ziekenhuis, Breda, The Netherlands., Stommel MW; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Wit F; Department of Surgery, Tjongerschans Ziekenhuis, Heerenveen, The Netherlands., Zonderhuis BM; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands., de Meijer VE; Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., van Santvoort HC; Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht and St Antonius Hospital Nieuwegein, Utrecht, The Netherlands., Molenaar IQ; Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht and St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2022 Jan 01; Vol. 275 (1), pp. e222-e228.
DOI:	10.1097/SLA.0000000000003835
Abstrakt:	Objective: To quantify the impact of individual complications on mortality, organ failure, hospital stay, and readmission after pancreatoduodenectomy. Summary of Background Data: An initial complication may provoke a sequence of adverse events potentially leading to mortality after pancreatoduodenectomy. This study was conducted to aid prioritization of quality improvement initiatives. Methods: Data from consecutive patients undergoing pancreatoduodenectomy (2014-2017) were extracted from the Dutch Pancreatic Cancer Audit. Population attributable fractions (PAF) were calculated for the association of each complication (ie, postoperative pancreatic fistula, postpancreatectomy hemorrhage, bile leakage, delayed gastric emptying, wound infection, and pneumonia) with each unfavorable outcome [ie, in-hospital mortality, organ failure, prolonged hospital stay (>75th percentile), and unplanned readmission), whereas adjusting for confounders and other complications. The PAF represents the proportion of an outcome that could be prevented if a complication would be eliminated completely. Results: Overall, 2620 patients were analyzed. In-hospital mortality occurred in 95 patients (3.6%), organ failure in 198 patients (7.6%), and readmission in 427 patients (16.2%). Postoperative pancreatic fistula and postpancreatectomy hemorrhage had the greatest independent impact on mortality [PAF 25.7% (95% CI 13.4-37.9) and 32.8% (21.9-43.8), respectively] and organ failure [PAF 21.8% (95% CI 12.9-30.6) and 22.1% (15.0-29.1), respectively]. Delayed gastric emptying had the greatest independent impact on prolonged hospital stay [PAF 27.6% (95% CI 23.5-31.8)]. The impact of individual complications on unplanned readmission was smaller than 11%. Conclusion: Interventions focusing on postoperative pancreatic fistula and postpancreatectomy hemorrhage may have the greatest impact on in-hospital mortality and organ failure. To prevent prolonged hospital stay, initiatives should in addition focus on delayed gastric emptying. Competing Interests: The author reports no conflicts of interest. (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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