INTRODUCTION. Preoperative risk stratification can be useful in choosing the whole therapeutical strategies for patients(pts) with pancreatic disease and allows to calculate the risk-benefit balance of surgery. A prediction of the postoperative risk is fundamental for planning the post-operative measures to be taken. OBJECTIVES. The aim of our study was to identify the more important pre-operative variables that affect pts outcome after major pancreatic surgery. METHODS. We collected the data of pts operated for major pancreatic surgery during a 12-month period from two clinical data- base (University Hospital of Verona and Peschiera Pederzoli Clinic). Outcome data included incidence of postoperative complications, hospital mortality, ICU admission and days of hospitalization. The level of risk was determined by considering BMI, smoking habitus, presence of jaundice, pre-operative drainage of jaundice, recent che- miotherapy, anamnesis positive for cardiovascular, pulmonary, renal, neurological disease and an American Society of Anesthesiologist (ASA) score ≥3. RESULTS. A total of 638 pts (320 women and 318 man, mean±sd age 61.41±12.52 years) were operated of major pancreatic surgery in the two hospitals. 18.8% of these patients were ASA ≥3 pts. ICU admission was 8.9%. Total post-operative complications were 57.6%, mortality was 2.2%. We observed abdominal complications and gen- eral complications (cardiac, respiratory, infectious and renal) in in 43.5%and 34.1%, respectively. Mean surgical duration was 332.81 ±106.05 minutes, and mean duration of hospitalizations was 15.94 ±17.83 days. ASA≥3 patients presented higher peri-operative compli- cations and in-hospital mortality than low ASA group, (5.8%vs1.3%, p. < 0.01, chi-square test). Intraoperative blood losses, the need of ICU admission (26.7%vs4.8%, p.< 0.01) and the mean length of in- hospital stay (20.90±25vs14.81±15.55 days, p.< 0.01) were higher in high ASA group as well. The percentage of complication with DGE, biliary-fistula (7.1%vs 3.8%, p. < 0.01), mean duration of surgery, is- chemic cardiovascular complications were higher in group with pre- operative jaundice. CONCLUSIONS. We found good correlation between ASA status and development of peri-operative general complications. Also intraoper- ative blood losses and length of hospitalization was well related to ASA status. Presence of pre-operative jaundice is strongly related to development of post-operative abdominal complications like enteric or biliary fistula. Overall mortality was higher in high ASA status group. Our data enforce the utility of the development of an easily applied scoring system with convincing accuracy for identifying high-risk patients, based on preoperatively assessable characteristics, which could be very useful in choosing the right therapeutic strat- egy, expecially for low-malignant risk lesions.

The influence of pre-operative physical status on morbidity and mortality of patients undergoing major pancreatic surgery

Cigolini Davide;Donadello Katia;Salvia Roberto;Schweiger Vittorio;Bassi Claudio;Polati Enrico
2018

Abstract

INTRODUCTION. Preoperative risk stratification can be useful in choosing the whole therapeutical strategies for patients(pts) with pancreatic disease and allows to calculate the risk-benefit balance of surgery. A prediction of the postoperative risk is fundamental for planning the post-operative measures to be taken. OBJECTIVES. The aim of our study was to identify the more important pre-operative variables that affect pts outcome after major pancreatic surgery. METHODS. We collected the data of pts operated for major pancreatic surgery during a 12-month period from two clinical data- base (University Hospital of Verona and Peschiera Pederzoli Clinic). Outcome data included incidence of postoperative complications, hospital mortality, ICU admission and days of hospitalization. The level of risk was determined by considering BMI, smoking habitus, presence of jaundice, pre-operative drainage of jaundice, recent che- miotherapy, anamnesis positive for cardiovascular, pulmonary, renal, neurological disease and an American Society of Anesthesiologist (ASA) score ≥3. RESULTS. A total of 638 pts (320 women and 318 man, mean±sd age 61.41±12.52 years) were operated of major pancreatic surgery in the two hospitals. 18.8% of these patients were ASA ≥3 pts. ICU admission was 8.9%. Total post-operative complications were 57.6%, mortality was 2.2%. We observed abdominal complications and gen- eral complications (cardiac, respiratory, infectious and renal) in in 43.5%and 34.1%, respectively. Mean surgical duration was 332.81 ±106.05 minutes, and mean duration of hospitalizations was 15.94 ±17.83 days. ASA≥3 patients presented higher peri-operative compli- cations and in-hospital mortality than low ASA group, (5.8%vs1.3%, p. < 0.01, chi-square test). Intraoperative blood losses, the need of ICU admission (26.7%vs4.8%, p.< 0.01) and the mean length of in- hospital stay (20.90±25vs14.81±15.55 days, p.< 0.01) were higher in high ASA group as well. The percentage of complication with DGE, biliary-fistula (7.1%vs 3.8%, p. < 0.01), mean duration of surgery, is- chemic cardiovascular complications were higher in group with pre- operative jaundice. CONCLUSIONS. We found good correlation between ASA status and development of peri-operative general complications. Also intraoper- ative blood losses and length of hospitalization was well related to ASA status. Presence of pre-operative jaundice is strongly related to development of post-operative abdominal complications like enteric or biliary fistula. Overall mortality was higher in high ASA status group. Our data enforce the utility of the development of an easily applied scoring system with convincing accuracy for identifying high-risk patients, based on preoperatively assessable characteristics, which could be very useful in choosing the right therapeutic strat- egy, expecially for low-malignant risk lesions.
pancreatic surgery, pre-operative status, morbidity, mortality
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11562/997732
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