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01-10-2018 | Original Article

Synergistic Effects of Perioperative Complications on 30-Day Mortality Following Hepatopancreatic Surgery

Authors: Katiuscha Merath, Qinyu Chen, Fabio Bagante, Ozgur Akgul, Jay J. Idrees, Mary Dillhoff, Jordan M Cloyd, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 10/2018

Abstract

Background

Data on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following hepatopancreatic surgery have not been reported. The objective of the current study was to define the interaction effect of postoperative complications among patients undergoing HP surgery on 30-day mortality.

Methods

Using the ACS-NSQIP Procedure Targeted Participant Use Data File, patients who underwent HP surgery between 2014 and 2016 were identified. Hazard ratios (HRs) for 30-day mortality were estimated using Cox proportional hazard models. Two-way interaction effects assessing combinations of complications relative to 30-day mortality were calculated using the relative excess risk due to interaction (RERI) in separate adjusted Cox models.

Results

Among 26,824 patients, 10,886 (40.5%) experienced at least one complication. Mortality was higher among patients who experienced at least one complication versus patients who did not experience a complication (3.0 vs 0.1%, p < 0.001). The most common complications were blood transfusion (16.9%, n = 4519), organ space infection (12.2%, n = 3273), and sepsis/septic shock (8.2%, n = 2205). Combinations associated with additive effect on mortality included transfusion + renal dysfunction (RERI 12.3, 95% CI 5.2–19.4), pulmonary dysfunction + renal dysfunction (RERI 60.9, 95% CI 38.6–83.3), pulmonary dysfunction + cardiovascular complication (RERI 144.1, 95% CI 89.3–199.0), and sepsis/septic shock + renal dysfunction (RERI 11.5, 95% CI 4.4–18.7).

Conclusion

Both the number and specific type of complication impacted the incidence of postoperative mortality among patients undergoing HP surgery. Certain complications interacted in a synergistic manner, leading to a greater than expected increase in the risk of short-term mortality.

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Title: Synergistic Effects of Perioperative Complications on 30-Day Mortality Following Hepatopancreatic Surgery
Authors: Katiuscha Merath
Qinyu Chen
Fabio Bagante
Ozgur Akgul
Jay J. Idrees
Mary Dillhoff
Jordan M Cloyd
Timothy M. Pawlik
Publication date: 01-10-2018
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 10/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-3829-3

ACC 2024 Congress

Springer Medicine

Synergistic Effects of Perioperative Complications on 30-Day Mortality Following Hepatopancreatic Surgery

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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