Predictors of post-operative complications following pancreaticoduodenectomy


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Andrew Nickinson1,Gavin Smith1,Iseult Flynn1,Mohammed Abu-Hilal1,Zaed Hamady1
1University Hospital Southampton

Abstract

Background

Pancreaticoduodenectomy (Whipple resection) remains the only curative treatment option in patients with periampullary cancers, however the procedure is associated with significant morbidity. Even in high volume centres post-operative morbidity ranges from 30-60%. Although there is increasing work investigating peri-operative predictors of mortality there remains a paucity of information regarding risk factors for complications. We aim to identify peri-operative predictors of post-operative complications following pancreaticoduodenectomy.

Method

Retrospective analysis of all patients undergoing pancreatiticoduodenectomy (standard and pylorus-preserving procedures) at the University Hospital Southampton between 2010-2015. Data on patient demographics and pre-operative factors (BMI, current smoking, diabetes (type 1 and 2)) were collected. Operation length and intra-operative blood loss were also recorded. Data was collected on 90-day morbidity (pancreatic fistula, bile leak, wound infection, cardiovascular complications). Risk factors for complications were identified using multivariate logistic regression. Only patients with complete data were included for analysis.

Results

136 patients were included for multivariate analysis. 90-day morbidity was 21.3% (29/132). Smoking was strongly associated with the development of post-operative complications (OR 4.28, p=0.024). Patients who were overweight (BMI 25-30) and obese (BMI>30) were also shown to have significantly increased odds of developing post-operative complications (OR 1.8 and 2.6 respectively, p=0.037). Pre-operative history of diabetes and intra-operative blood loss were not associated with the development of complications.

Conclusion

Our data indicates that smoking and obesity are associated with increased post-operative morbidity. Pre-operative optimisation of these risk factors may therefore help improve post-operative outcome in patients undergoing this challenging surgery.