Risk factors for complications in patients undergoing pancreaticoduodenectomy: A NSQIP analysis with propensity score matching

Abstract

Background Reports on the safety of minimally invasive pancreaticoduodenectomy compared to open pancreaticoduodenectomy (OPD) have demonstrated mixed results. One study comparing robotic pancreaticoduodenectomy (RPD) vs OPD demonstrated decreased complications associated with RPD. Objectives To evaluate the morbidity of RPD vs OPD using a national data set. Methods This is a retrospective cohort study from 2014 to 2017. Factors associated with complications in patients undergoing pancreaticoduodenectomy were evaluated using multivariate logistic regression (MVA) and propensity score matching (PSM). Results Of 13 110 PDs performed over the study period, 12 612 (96.2%) were OPD and 498 (3.8%) were RPD. Patients who underwent RPD vs OPD were less likely to have any complications (46.8% vs 53.3%; P = .004), surgical complications (42.6% vs 48.6%; P = .008), wound complications (6.2% vs 9.1%; P = .029), clinically relevant postoperative pancreatic fistulas (11.9% vs 15.6%; P = .026), sepsis (6.2% vs 9.3%; P = .019), and pneumonia (1.6% vs 3.8%; P = .012). On MVA, OPD was associated with increased complications compared with RPD. On PSM analysis, OPD remained a significant predictor for any (OR, 1.29; 95% CI, 1.03‐1.61; P = .029) and surgical (OR, 1.26; 95% CI, 1.00‐1.58; P = .048) complications. Conclusions This is the largest multicenter study to evaluate the impact of RPD on morbidity and suggests RPD is associated with decreased morbidity.

State of the art of robotic pancreatoduodenectomy

“…In comparison with LPD, RPD was associated with lower rates of bleeding requiring transfusions (10.4% vs 17.4%; p = 0.002). Rates of 30-day readmission were higher after RPD than after either OPD (24.3% vs 16.2%; p < 0.001) or LPD (24.3% vs 15.5%; p = 0.001) [39].…”

“…In this study, RPD was also associated with decreased median time to drain removal (4 vs 7 days; p < 0.001). Despite a similar incidence of CR-POPF in RPD and LPD, more patients required a percutaneous catheter drainage after LPD (10.8% vs 15.7%; p = 0.030) [39].…”

New score for prediction of morbidity in patients undergoing open pancreaticoduodenectomy

“…9 However, the incidence of complications after pancreaticoduodenectomy is still higher than 45%, 10,11 which seriously affects patients’ prognosis, prolongs the hospital stay, increases the cost of hospitalization, and causes postoperative systemic inflammation, multiple organ failure, and even death. 9,10 Although the risk factors for complications after OPD have been confirmed by many studies, few studies have constructed a scoring system to predict the occurrence of complications after OPD. Therefore, it is necessary to establish effective postoperative complication risk stratification tools for patients undergoing OPD.…”

Current state of minimally invasive pancreatic surgery

“…However, a recent analysis of the ACS‐NSQIOP database showed, both before and after propensity‐score matching, a disadvantage in overall complications (OR, 1.29; p = .029) and surgical complications (OR, 1.26; p = .048) with an open compared to robotic approach. This benefit of RPD was not evident for the patients undergoing surgery for PDAC 50 …”

“…As shown with other procedures, RPD is often associated with longer operating room times and minimized blood loss 47,49,50 . One multi‐centered analysis from Zureikat et al 47 only included operations from high‐volume centers performed by surgeons past the “learning curve” of RPD and OPD (>80), and it is therefore unlikely these intraoperative differences can be attributed to surgeon experience.…”