Published in:
01-10-2012 | 2011 SSAT Poster Presentation
Targeting Early Deaths Following Pancreaticoduodenectomy to Improve Survival
Published in: Journal of Gastrointestinal Surgery | Issue 10/2012
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Introduction
There is increasing focus on disease-specific outcomes. This study was undertaken to analyze early mortality after pancreaticoduodenectomy as part of a strategy to improve long-term outcome.
Methods
One thousand thirty-one patients who underwent pancreaticoduodenectomy from 1992 to 2010 were studied. Median data are reported.
Results
Fifty-eight (5.6 %) patients died within 90 days after pancreaticoduodenectomy. All patients had at least one significant comorbidity, commonly cardiorespiratory in nature (76 %). Sixty percent of patients had depressed serum albumin levels, and 43 % were jaundiced. The American Society of Anesthesiologists class was: 17 % class II, 72 % class III, and 10 % class IV. Seventy-four percent had malignant disease. Twenty-two percent of patients underwent a major vascular resection at the time of pancreaticoduodenectomy. Causes of death were vascular/bleeding related (26 %), cardiorespiratory causes (17 %), multiorgan failure (12 %), leak/perforation (10 %), cancer progression (9 %), infection (7 %), or indeterminate (19 %).
Conclusions
Death within 90 days after pancreaticoduodenectomy is uncommon, occurs in relatively older deconditioned patients, and is generally not causally related to underlying malignancy. Early death is generally associated with vascular or bleeding complications. Strategies to minimize early death should focus on careful patient selection and prompt recognition and management of herald bleeding or vascular thrombosis, as it can often result in perioperative death following pancreaticoduodenectomy.