For citation purposes: Annamalai A, Kakarla VR, Nandipati K. Predictors of mortality following pancreaticoduodenectomy for periampullary cancer. OA Surgery 2014 Jan 18;2(1):2.

Research study

 
Upper GI Surgery

Predictors of mortality following pancreaticoduodenectomy for periampullary cancer

A Annamalai, VR Kakarla, K Nandipati
 

Authors affiliations

(1) Cedars-Sinai Medical Center, Department of Abdominal Transplant and Hepatopancreaticobiliary Surgery, Los Angeles, 90048, CA, USA

(2) University of Illinois, Department of Surgery, Chicago, 60612, USA

(3) Emory University, Department of Surgery, Atlanta, 30322, USA

* Corresponding author Email: alagappan.annamalai@cshs.org

Abstract

Introduction

Pancreaticoduodenectomy is associated with significant post-operative morbidity and mortality. Identifying the pre-operative factors that increase the risk of post-operative morbidity might improve patient selection and risk stratification, and may lead to better outcomes. The aim of this article was to evaluate the predictors of mortality following pancreaticoduodenectomy for periampullary cancer.

Materials and Methods

Using the American College of Surgeons–National Surgical Quality Improvement Project’s participant-use file, we identified all patients who underwent pancreaticoduodenectomy (Whipple) for periampullary cancer at the 240 participating hospitals. Demographic, clinical and intra-operative variables and 30-day morbidity and mortality were collected in standardised fashion.

Results

From the 2005 to 2008 databases, we identified 3072 patients who underwent pancreaticoduodenectomy. The 30-day mortality following Whipple was 3% (92/3072). Pre-operative factors leading to increased risk of mortality included: age >55 years (OR 2.65, P = 0.005), non-insulin dependent diabetes (NIDDM) (OR 1.7, P = 0.0423), dyspnoea at rest (OR 7.14, P = 0.013) and with moderate exercise (OR 2.4, P = 0.0037), chronic obstructive pulmonary disease (COPD) (OR 2.8, P = 0057), ascites (OR 4.3, P = 0.0411), congestive heart failure (CHF) (OR 33.8, P < 0.0001), hypertension (OR 1.8, P = 0.0076) and acute renal failure (OR 16.53, P = 0.0123); albumin < 2.5, elevated blood urea nitrogen (BUN), partial thromboplastin time (PTT) and international normalized ratio (INR). Peri-operative and post-operative factors that increase the risk of mortality were operative time, organ space infection, pneumonia, septic shock, unplanned intubation, renal failure and myocardial infarction.

Conclusion

Recognising the risk factors pre-operatively may help guide physicians in the management of these patients. Optimising patient selection and risk stratification is crucial in these patients and will likely lead to improved outcomes and quality of life.

Licensee OA Publishing London 2014. Creative Commons Attribution License (CC-BY)
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