Experience of 215 totally laparoscopic pancreatoduodenectomies

Abstract

Background: The data regarding risk factors of postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) following pancreaticoduodenectomy (PD) are limited. The purpose of this study is to identify independent risk factors of both DVT and PE in patients undergoing PD for malignancy or neoplasm. Methods: Patients who underwent PD for malignancy or neoplasm from 2010 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Multivariate analysis using logistic regression was used to identify independent risk factors for post-operative DVT and PE. Results: 17,742 patients underwent PD for cancer or neoplasm during this time period. Subjects were predominately white (78.4%) males (53.6%) with length of stay (LOS) of 9 (7e14) days. 30-day mortality was 1.4%. Rates of post-operative DVT and PE were 2.7% and 1.1%, respectively. Only 42 (21.5%) patients with a diagnosis of PE had concomitant DVT reported. PE was diagnosed on hospital readmission in 24 (12.3%) patients. Independent risk factors for the development of DVT were ASA score 3 (OR 1.39 [1.05e1.85]), operative time >6 hours (OR 1.47 [1.19e1.83]), LOS 1 week (OR 3.63 [2.62e5.03]), and presence of bleeding disorder (OR 2.02 [1.29e3.17]). PE was independently associated with LOS 1 week (OR 3.37 [2.08e5.47]), malignancy (OR 1.66 [1.13e2.43]), and post-operative DVT (OR 8.26 [5.56e12.23]). Overall complication rate was increased when DVT or PE occurred (OR 4.31 [3.59e 5.17] and 4.21 [3.17e5.59]). Conclusion: Multiple risk factors are independently associated with post-operative DVT and PE following PD. A majority of patients with post-operative PE did not have a preceding diagnosis of DVT. Further investigation into the routine use of DVT screening and extended chemoprophylaxis in high-risk patients should be considered.