TY - JOUR
T1 - Impact of Complications after Pancreatoduodenectomy on Mortality, Organ Failure, Hospital Stay, and Readmission Analysis of a Nationwide Audit
AU - Jasmijn Smits, F.
AU - Verweij, Maaike E.
AU - Daamen, Lois A.
AU - Henri van Werkhoven, C.
AU - Goense, Lucas
AU - Besselink, Marc G.
AU - Bonsing, Bert A.
AU - Busch, Olivier R.
AU - van Dam, Ronald M.
AU - van Eijck, Casper H. J.
AU - Festen, Sebastiaan
AU - Koerkamp, Bas Groot
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - Kazemier, Geert
AU - Klaase, Joost M.
AU - van der Kolk, Marion
AU - Liem, Mike
AU - Luyer, Misha D. P.
AU - Meerdink, Mark
AU - Sven D. Mieog, J.
AU - Nieuwenhuijs, Vincent B.
AU - Roos, Daphne
AU - Schreinemakers, Jennifer M.
AU - Stommel, Martijn W.
AU - Wit, Fennie
AU - Zonderhuis, Babs M.
AU - de Meijer, Vincent E.
AU - van Santvoort, Hjalmar C.
AU - Quintus Molenaar, I.
N1 - Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - 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.
AB - 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.
KW - Complications
KW - Pancreas
KW - Quality improvement
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85122278940&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000003835
DO - https://doi.org/10.1097/SLA.0000000000003835
M3 - Article
C2 - 32502075
SN - 0003-4932
VL - 275
SP - E222-E228
JO - Annals of surgery
JF - Annals of surgery
IS - 1
ER -