Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factor

Rystedt, Jenny; Tingstedt, Bobby; Ansorge, Christoph; Nilsson, Johan; Andersson, Bodil

doi:10.1016/j.hpb.2018.07.024

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…As shown previously 11 , national 30‐ and 90‐day mortality rates were low in comparison with contemporary cohorts from Germany, France and the USA, and in line with rates reported from Sweden and the Netherlands 1,2,26–28 . Rates of any major complication, CR POPF and PPH grade C were equal to coeval cohorts from the USA, Netherlands and Germany 22,29,30 . The relaparotomy rate in the present cohort (18·1 per cent) was similar to, or somewhat higher than, that reported from other studies 22,30,31 .…”

Section: Discussionsupporting

confidence: 89%

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Centralizing a national pancreatoduodenectomy service: striking the right balance

et al. 2020

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Background: Centralization of pancreatic surgery is currently called for owing to superior outcomes in higher-volume centres. Conversely, organizational and patient concerns speak for a moderation in centralization. Consensus on the optimal balance has not yet been reached. This observational study presents a volume-outcome analysis of a complete national cohort in a health system with long-standing centralization. Methods: Data for all pancreatoduodenectomies in Norway in 2015 and 2016 were identified through a national quality registry and completed through electronic patient journals. Hospitals were dichotomized (high-volume (40 or more procedures/year) or medium-low-volume). Results: Some 394 procedures were performed (201 in high-volume and 193 in medium-low-volume units). Major postoperative complications occurred in 125 patients (31⋅7 per cent). A clinically relevant postoperative pancreatic fistula occurred in 66 patients (16⋅8 per cent). Some 17 patients (4⋅3 per cent) died within 90 days, and the failure-to-rescue rate was 13⋅6 per cent (17 of 125 patients). In multivariable comparison with the high-volume centre, medium-low-volume units had similar overall complication rates, lower 90-day mortality (odds ratio 0⋅24, 95 per cent c.i. 0⋅07 to 0⋅82) and no tendency for a higher failure-to-rescue rate. Conclusion: Centralization beyond medium volume will probably not improve on 90-day mortality or failure-to-rescue rates after pancreatoduodenectomy.

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Section: Discussionsupporting

confidence: 89%

“…The relaparotomy rate in the present cohort (18·1 per cent) was similar to, or somewhat higher than, that reported from other studies 22,30,31 . Compared with similar population‐based cohorts 29,30 , the median operating time of 322 min was short and median estimated blood loss (350 ml) was low.…”

Section: Discussionsupporting

confidence: 83%

Centralizing a national pancreatoduodenectomy service: striking the right balance

et al. 2020

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“…The negative impact of IBL on outcomes after pancreatic surgery has long been suspected [ 29 – 34 ]; however, there have been few reports demonstrating risk factors for IBL [ 32 , 33 ]. Rystedt et al retrospectively analyzed 1864 patients who had undergone a PD in the Swedish National Pancreatic and Periampullary Cancer Registry.…”

Section: Discussionmentioning

confidence: 99%

“…Rystedt et al retrospectively analyzed 1864 patients who had undergone a PD in the Swedish National Pancreatic and Periampullary Cancer Registry. The national study on resectable periampullary tumors shows that the preoperative independent risk factors associated with major IBL (≥1000 mL) were male sex, body mass index ≥25 kg/m 2 , preoperative biliary drainage, C-reactive protein ≥12 mg/L, and neo-adjuvant chemotherapy treatment [ 32 ]. Seykora et al conducted a multi-institutional retrospective study and precisely evaluated 5323 PD patients who had been treated for either benign or malignant disease by 62 surgeons from 17 institutions [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Prediction of massive bleeding in pancreatic surgery based on preoperative patient characteristics using a decision tree

et al. 2021

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Massive intraoperative blood loss (IBL) negatively influence outcomes after surgery for pancreatic ductal adenocarcinoma (PDAC). However, few data or predictive models are available for the identification of patients with a high risk for massive IBL. This study aimed to build a model for massive IBL prediction using a decision tree algorithm, which is one machine learning method. One hundred and seventy-five patients undergoing curative surgery for resectable PDAC at our facility between January 2007 and October 2020 were allocated to training (n = 128) and testing (n = 47) sets. Using the preoperatively available data of the patients (34 variables), we built a decision tree classification algorithm. Of the 175 patients, massive IBL occurred in 88 patients (50.3%). Binary logistic regression analysis indicated that alanine aminotransferase and distal pancreatectomy were significant predictors of massive IBL occurrence with an overall correct prediction rate of 70.3%. Decision tree analysis automatically selected 14 predictive variables. The best predictor was the surgical procedure. Though massive IBL was not common, the outcome of patients with distal pancreatectomy was secondarily split by glutamyl transpeptidase. Among patients who underwent PD (n = 83), diabetes mellitus (DM) was selected as the variable in the second split. Of the 21 patients with DM, massive IBL occurred in 85.7%. Decision tree sensitivity was 98.5% in the training data set and 100% in the testing data set. Our findings suggested that a decision tree can provide a new potential approach to predict massive IBL in surgery for resectable PDAC.

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“…A study based on SEER database in USA showed that the utilization of preoperative biliary stent placement doubled from 1992 to 2007 [2]. However, since the 21st century, with the continuous progress of surgical technology and perioperative management, more and more studies have shown that PBD could not bene t the patients, on the contrary, it can increase the postoperative complications [3][4][5][6][7][8][9]. But in clinical practice, there are still many situations that patients need PBD due to different reasons.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Preoperative Biliary Drainage on Postoperative Outcomes after Pancreaticoduodenectomy: A Single Center Retrospective Study

Wang

et al. 2020

Preprint

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Background The effect of preoperative biliary drainage (PBD) on the short-term outcomes after pancreaticoduodenectomy (PD) remains controversial. Methods 164 consecutive patients with obstructive jaundice who underwent PD in our center from 2016 to 2017 were retrospectively analyzed. The 120 patients who underwent PBD prior to PD (PBD group) were compared with 44 patients who did not (DS group). The short-term outcomes include overall morbidity, severe complications, postoperative pancreatic fistula(POPF), postpancreatectomy hemorrhage(PPH), intra-abdominal abscess (IAA), sepsis, delayed gastric emptying (DGE), postoperative hospital stay and 90-day death were assesed. Results There were no significant statistical differences in overall morbidity, severe complications, POPF, PPH, IAA, LOS and ninety-day mortality between two groups. The incidence of DGE in PBD group was significantly lower than that in DS group (4.5% vs. 19.2%, P = 0.021). Multivariate regression analysis showed that age over 66 years (OR: 3.094,95% CI: 1.268-7.55) and direct surgery (OR: 5.298, 95% CI: 1.176-23.865) were independent risk factors for DGE. Conclusion For patients with obstructive jaundice, preoperative biliary drainage is independently associated with delayed gastric emptying, but does not affect the overall morbidity and mortality of patients undergoing PD.

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Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factor

Cited by 12 publications

References 21 publications

Centralizing a national pancreatoduodenectomy service: striking the right balance

Centralizing a national pancreatoduodenectomy service: striking the right balance

Prediction of massive bleeding in pancreatic surgery based on preoperative patient characteristics using a decision tree

The Impact of Preoperative Biliary Drainage on Postoperative Outcomes after Pancreaticoduodenectomy: A Single Center Retrospective Study

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