Assessment of Risk Factors for Postoperative Mortality Following Pancreaticoduodenectomy Performed for Malignancy: A Cross-sectional Study
Correspondence Address :
Dr. Salih Demirelli,
Department of General Surgery, University of Health Sciences, Ankara, Turkey.
E-mail: dr.salihdemirelli@gmail.com
Introduction: Pancreaticoduodenectomy (PD) has been the primary curative-intent surgical option for resectable periampullary tumours. Despite advancements in relevant surgical techniques, PD-related morbidity and mortality rates continue to remain high. Therefore, the preoperative identification of high-risk patients is vital for tailoring PD approaches to the individual patient.
Aim: To assess early postoperative morbidity and mortality following PD in a tertiary centre in Turkey and identify the associated risk factors.
Materials and Methods: This cross-sectional, single-centre study conducted in the General Surgery Clinics of Ankara Numune Training and Education Hospital in Ankara, Turkey included a population of 64 patients undergoing PD for malignant periampullary tumours between May 2010 and May 2014. Patients’ demographic, clinical and intraoperative data were collected. The primary outcome of the study was the 30-day postoperative mortality rate. Pearson’s Chi-square, Fisher’s-exact and Fisher-Freeman-Halton tests were used to compare differences in categorical variables between the groups.
Results: The study sample consisted of 64 patients with a mean age of 60.1±12.4 years. The 30-day postoperative mortality rate in the sample was 18.75%. Non survivors were significantly older (age >70 years) (p=0.006), had significantly higher American Society of Anaesthesiologists (ASA) physical status classes (>III) (p=0.008), had significantly lower Neutrophil-to-lymphocyte Ratios (NLR) (<2.5) (p<0.001) and had significantly lower serum albumin levels (<3.5 g/dL) (p=0.038) compared to survivors. The rate of patients experiencing intraoperative blood loss exceeding 1000 mL and consequently the median number of blood units transfused, was significantly higher in non survivors than in survivors (p<0.009 and p<0.001, respectively). Similarly, overall and major complications were significantly more common in non survivors than in survivors (p=0.002 and p=0.012, respectively).
Conclusion: The findings of the study indicated that a higher ASA class, older age, lower NLR, hypoalbuminemia, higher intraoperative blood loss, the need for blood transfusion and postoperative complications were associated with increased 30-day mortality after PD.
In-hospital mortality, Morbidity, Postoperative complications
DOI: 10.7860/JCDR/2024/72776.20202
Date of Submission: May 20, 2024
Date of Peer Review: Jun 27, 2024
Date of Acceptance: Aug 29, 2024
Date of Publishing: Oct 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 23, 2024
• Manual Googling: Jun 29, 2024
• iThenticate Software: Aug 28, 2024 (12%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com