Postpancreatectomy Hemorrhage—Incidence, Treatment, and Risk Factors in Over 1,000 Pancreatic Resections
| Autor: | Ulrich T. Hopt, Ulrich F. Wellner, Hryhoriy Lapshyn, Olivia Sick, B Kulemann, Tobias Keck, Dirk Bausch, Jens Hoeppner, Frank Makowiec |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Blood transfusion Adolescent medicine.medical_treatment Postoperative Hemorrhage Severity of Illness Index Body Mass Index Pancreaticoduodenectomy Pancreatic Fistula Young Adult Pancreatectomy Sex Factors Risk Factors Pancreaticojejunostomy Severity of illness medicine Humans Blood Transfusion Risk factor Child Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Incidence Hemostasis Endoscopic Age Factors Angiography Gastroenterology Pancreatic Diseases Retrospective cohort study Middle Aged medicine.disease Surgery Pancreatic fistula Female Clinical Competence Radiology business |
| Zdroj: | Journal of Gastrointestinal Surgery. 18:464-475 |
| ISSN: | 1873-4626 1091-255X |
| Popis: | Postpancreatectomy hemorrhage is a rare but often severe complication after pancreatic resection. The aim of this retrospective study was to define incidence and risk factors of postpancreatectomy hemorrhage and to evaluate treatment options and outcome. Clinical data was extracted from a prospectively maintained database. Descriptive statistics, univariate and multivariate risk factor analysis by binary logistic regression were performed with SPSS software at a significance level of p = 0.05. N = 1,082 patients with pancreatic resections between 1994 and 2012 were included. Interventional angiography was successful in about half of extraluminal bleeding. A total of 78 patients (7.2 %) had postpancreatectomy hemorrhage (PPH), and 29 (2.7 %) were grade C PPH. Multivariate modeling disclosed a learning effect, age, BMI, male sex, intraoperative transfusion, portal venous and multivisceral resection, pancreatic fistula and preoperative biliary drainage as independent predictors of severe postpancreatectomy hemorrhage. High-risk histopathology, age, transfusion, pancreatic fistula, postpancreatectomy hemorrhage and pancreatojejunostomy in pancreatoduodenectomies were independent predictors of mortality. Our study identifies clinically relevant risk factors for postpancreatectomy hemorrhage and mortality. Interventional treatment of extraluminal hemorrhage is successful in about half of the cases and if unsuccessful constitutes a valuable adjunct to operative hemostasis. Based on our observations, we propose a treatment scheme for PPH. Risk factor analysis suggests appropriate patient selection especially for extended resections and pancreatogastrostomy for reconstruction in pancreatoduodenectomy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink