INTRODUCTION AND OBJECTIVES. Some intra-operative variables may significantly affect patient outcomes after major pancreatic sur- gery. The identification of one or more of them could be very useful for choosing the best intra-operative management and for planning the best measures to be taken in the post-operative period. METHODS. We collected data of patients operated for major pancreatic surgery during 12-month period from two clinical data- bases (Verona University Hospital and Peschiera Pederzoli Clinic). We took into account the following preoperative variables: BMI, smoking habitus, presence of jaundice, pre-operative drainage of jaundice, recent chemotherapy, anamnesis positive for cardiovascular, pulmonary, renal, neurological disease and the American Society of Anesthesiologist (ASA) score. Recorded outcome data included incidence of postoperative ab- dominal surgical-related complications, systemic complications (infec- tious, respiratory, cardiovascular, nefrologic and neurologic), in-hospital mortality, ICU admission and days of hospitalization. RESULTS. A total of 638 (320 women and 318 men, aged 61.4±12.5 years, mean + SD) were operated of major pancreatic surgery during 2013 and 2014 in the two hospitals. ICU admission was 8.9%. Total of post-operative complications were 57.6%,in-hospital mortality was 2.2%. We observed abdominal surgical-related complications in 43.5% and general complications (cardiac, respiratory, infectious and renal) in 34.1% of total patients. Mean ± SD surgical time was 333 ±106 minutes, and mean hospitalization was 16±18 days. Ten pa- tients (1.6%) needed intraoperative infusion of inotropes or vasopres- sors and 72 (11.4%) received blood products. Colloids were administered to 221 patients (34.9%), and 179 patients (28.2%) re- ceived more than 4500ml of cristalloids. The multivariate analysis showed that the incidence of abdominal complication was higher in group who received colloids (42.1%vs52%, p 0.017, O.R. 1.49 C.I.95% 1.073-2.069) and that the development of tachyarrhythmia in post-operative period was higher in the patients who received colloids (4.1%vs10%, p0.017, O.R. 2.245 C.I.95% 1.153-4.372) and when surgery time was longer than 300 mi- nutes. The incidence of cardiac ischemia (0.3%vs10%) and hearth fail- ure (0.3%vs10%) was higher in patients who needed infusion of inotropes or vasopressor during the surgery. All the analisys were ad- justed for sex, age and preoperative physical status. CONCLUSIONS. Our data suggest that the use of colloids, administration of cristalloids >4500ml and the infusion of inotropes or vasopressor can be related to development of post operative complication. These complications seem to be indipendent from pre-operative physical status and not influenced by sex and age. Also a time of surgery >300 minutes can be considered a risk factor for post operative complications.
Intra-operative management of major pancreatica surgery: what matters most?
Cigolini Davide;Donadello Katia
;Salvia Roberto;Schweiger Vittorio;Bassi Claudio;Polati Enrico
2018-01-01
Abstract
INTRODUCTION AND OBJECTIVES. Some intra-operative variables may significantly affect patient outcomes after major pancreatic sur- gery. The identification of one or more of them could be very useful for choosing the best intra-operative management and for planning the best measures to be taken in the post-operative period. METHODS. We collected data of patients operated for major pancreatic surgery during 12-month period from two clinical data- bases (Verona University Hospital and Peschiera Pederzoli Clinic). We took into account the following preoperative variables: BMI, smoking habitus, presence of jaundice, pre-operative drainage of jaundice, recent chemotherapy, anamnesis positive for cardiovascular, pulmonary, renal, neurological disease and the American Society of Anesthesiologist (ASA) score. Recorded outcome data included incidence of postoperative ab- dominal surgical-related complications, systemic complications (infec- tious, respiratory, cardiovascular, nefrologic and neurologic), in-hospital mortality, ICU admission and days of hospitalization. RESULTS. A total of 638 (320 women and 318 men, aged 61.4±12.5 years, mean + SD) were operated of major pancreatic surgery during 2013 and 2014 in the two hospitals. ICU admission was 8.9%. Total of post-operative complications were 57.6%,in-hospital mortality was 2.2%. We observed abdominal surgical-related complications in 43.5% and general complications (cardiac, respiratory, infectious and renal) in 34.1% of total patients. Mean ± SD surgical time was 333 ±106 minutes, and mean hospitalization was 16±18 days. Ten pa- tients (1.6%) needed intraoperative infusion of inotropes or vasopres- sors and 72 (11.4%) received blood products. Colloids were administered to 221 patients (34.9%), and 179 patients (28.2%) re- ceived more than 4500ml of cristalloids. The multivariate analysis showed that the incidence of abdominal complication was higher in group who received colloids (42.1%vs52%, p 0.017, O.R. 1.49 C.I.95% 1.073-2.069) and that the development of tachyarrhythmia in post-operative period was higher in the patients who received colloids (4.1%vs10%, p0.017, O.R. 2.245 C.I.95% 1.153-4.372) and when surgery time was longer than 300 mi- nutes. The incidence of cardiac ischemia (0.3%vs10%) and hearth fail- ure (0.3%vs10%) was higher in patients who needed infusion of inotropes or vasopressor during the surgery. All the analisys were ad- justed for sex, age and preoperative physical status. CONCLUSIONS. Our data suggest that the use of colloids, administration of cristalloids >4500ml and the infusion of inotropes or vasopressor can be related to development of post operative complication. These complications seem to be indipendent from pre-operative physical status and not influenced by sex and age. Also a time of surgery >300 minutes can be considered a risk factor for post operative complications.
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