Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients

Autor: Michael R. Driedger, Carlos A. Puig, Cornelius A. Thiels, John R. Bergquist, Daniel S. Ubl, Elizabeth B. Habermann, Travis E. Grotz, Rory L. Smoot, David M. Nagorney, Sean P. Cleary, Michael L. Kendrick, Mark J. Truty
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: BMC Surgery, Vol 20, Iss 1, Pp 1-9 (2020)
Druh dokumentu: article
ISSN: 1471-2482
54414288
DOI: 10.1186/s12893-020-00822-8
Popis: Abstract Background While emergent pancreatic resection for trauma has been previously described, no large contemporary investigations into the frequency, indications, and outcomes of emergent pancreatectomy (EP) secondary to complications of neoplastic disease exist. Modern perioperative outcomes data are currently unknown. Methods ACS-NSQIP was reviewed for all non-traumatic pancreatic resections (DP – distal pancreatectomy, PD - pancreaticoduodenectomy, or TP- total pancreatectomy) in patients with pancreatico-biliary or duodenal-ampullary neoplasms from 2005 to 2013. Patients treated for complications of pancreatitis were specifically excluded. Emergent operation was defined as NSQIP criteria for emergent case and one of the following: ASA Class 5, preoperative ventilator dependency, preoperative SIRS, sepsis, or septic shock, or requirement of > 4 units RBCs in 72 h prior to resection. Chi-square tests, Fisher’s exact tests were performed to compare postoperative outcomes between emergent and elective cases as well as between pancreatectomy types. Results Of 21,452 patients who underwent pancreatectomy for neoplastic indications, we identified 534 (2.5%) patients who underwent emergent resection. Preoperative systemic sepsis (66.3%) and bleeding (17.9%) were most common indications for emergent operation. PD was performed in 409 (77%) patients, DP in 115 (21%), and TP in 10 (2%) patients. Overall major morbidity was significantly higher (46.1% vs. 25.6%, p
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