caa a22 4500 445336412 CHVBK 20180317142757.0 cr unu---uuuuu 170323e20110801xx s 000 0 eng 10.1245/s10434-011-1594-6 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1594-6 Preoperative Factors Predict Perioperative Morbidity and Mortality After Pancreaticoduodenectomy [Elektronische Daten] [David Greenblatt, Kaitlyn Kelly, Victoria Rajamanickam, Yin Wan, Todd Hanson, Robert Rettammel, Emily Winslow, Clifford Cho, Sharon Weber] Background: Pancreaticoduodenectomy (PD) has long been associated with high rates of morbidity and mortality. The objective of this study was to identify preoperative risk factors for serious complications and mortality after PD and to construct a prediction tool to facilitate risk stratification prior to surgery. Materials and Methods: Patients who underwent elective PD from 2005 to 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Multivariate logistic regression identified predictors of 30-day serious complications and mortality. A prediction tool was created and validated in a sample of 1254 patients. Results: Of 4945 patients who underwent PD, 1342 (27.1%) suffered a serious complication and 127 (2.6%) died within 30days. The most frequent complications were sepsis (15.3%), surgical site infection (13.1%), and respiratory complications (9.5%). After adjusting for potential confounders, the significant predictors of morbidity included older age, male gender, overweight and obesity, dependent functional status, chronic obstructive pulmonary disease (COPD), steroid use, bleeding disorder, leukocytosis, elevated serum creatinine, and hypoalbuminemia. Significant predictors of 30-day mortality included COPD, hypertension, neoadjuvant radiation therapy, elevated serum creatinine, and hypoalbuminemia. Multivariable models were used to construct a preoperative risk stratification tool. Conclusions: Preoperative factors are associated with perioperative outcomes after PD. The prediction tool estimates the probability of early morbidity and mortality for patients undergoing PD. The tool may be used to provide information for patient counseling during the informed consent process and to identify high-risk patients for the purpose of tailoring perioperative care. Society of Surgical Oncology, 2011 Greenblatt David Department of Surgery, University of Wisconsin, Madison, WI, USA aut Kelly Kaitlyn Department of Surgery, University of Wisconsin, Madison, WI, USA aut Rajamanickam Victoria Department of Surgery, University of Wisconsin, Madison, WI, USA aut Wan Yin Department of Surgery, University of Wisconsin, Madison, WI, USA aut Hanson Todd Department of Surgery, University of Wisconsin, Madison, WI, USA aut Rettammel Robert Department of Surgery, University of Wisconsin, Madison, WI, USA aut Winslow Emily Department of Surgery, University of Wisconsin, Madison, WI, USA aut Cho Clifford Department of Surgery, University of Wisconsin, Madison, WI, USA aut Weber Sharon Department of Surgery, University of Wisconsin, Madison, WI, USA aut Annals of Surgical Oncology Springer-Verlag 18/8(2011-08-01), 2126-2135 1068-9265 18:8<2126 2011 18 10434 https://doi.org/10.1245/s10434-011-1594-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1594-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Greenblatt David Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Kelly Kaitlyn Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Rajamanickam Victoria Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Wan Yin Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Hanson Todd Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Rettammel Robert Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Winslow Emily Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Cho Clifford Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Weber Sharon Department of Surgery, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/8(2011-08-01), 2126-2135 1068-9265 18:8<2126 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer