LATE POSTPANCREATICODUODENECTOMY HEMORRHAGE: INCIDENCE, RISK FACTORS, MANAGEMENT AND OUTCOME.

Autor:	Jacquemin M; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Mokart D; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Faucher M; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Ewald J; Département de Chirurgie Oncologique, Institut Paoli Calmette, France., Tourret M; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Brun C; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Tezier M; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Mallet D; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Nguyen Duong L; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Cambon S; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Pouliquen C; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Ettori F; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Sannini A; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Gonzalez F; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Bisbal M; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Chow-Chine L; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Servan L; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., de Guibert JM; Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France., Boher JM; Unité de Biostatistique et de Méthodologie, Institut Paoli Calmette, France., Turrini O; Département de Chirurgie Oncologique, Institut Paoli Calmette, France., Garnier J; Département de Chirurgie Oncologique, Institut Paoli Calmette, France.
Jazyk:	angličtina
Zdroj:	Shock (Augusta, Ga.) [Shock] 2022 Nov 01; Vol. 58 (5), pp. 374-383. Date of Electronic Publication: 2022 Sep 27.
DOI:	10.1097/SHK.0000000000001999
Abstrakt:	Abstract: Background:Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods: Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results: The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality (P = 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis (P = 0.036), and on day 3, creatinine (P = 0.025), drain fluid amylase concentration (P = 0.023), lipase concentration (P < 0.001), and C-reactive protein (CRP) concentration (P < 0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions: Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring. Competing Interests: The author reports no conflicts of interest. (Copyright © 2022 by the Shock Society.)
Databáze:	MEDLINE
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