| Objective:To verify the value of the perioperative complication rating system used on pancreatic operations (pacreaticoduodenectomy or distal pancreatectomy) and elucidate the role of pancreatic fistula on overall operative complications during the postoperative period.Methods:The retrospective data was collected in a consecutive series of 341 patients undergoing pacreaticoduodenectomy or distal pancreatectomy from August 2005 to August 2009. The incidence and severity of the perioperative complications including pancreatic fistula, bile fistula, bleeding, abdominal abscess, delayed gastric emptying (DGE), cardiovascular event, wound infection, urinary tract infection, et al were analyzed by the ISGPS system and the classification of surgical complication. Meanwhile, the relationship between pancreatic fistula and the other complications was evaluated.Results:1. Among 341 patients, pancreatic fistula was observed in 158 patients (46.3%), there were 33.6% (53/158 cases) Grade A pancreatic fistula and 62% (98/158 cases) Grade B. Grade C pancreatic fistula was observed in 4.4% of patients. Meanwhile, delayed gastric emptying was documented in 35 patients (10.3%); abdominal bleeding in 17 patients (5.0%), cardiovascular event in 5 patients (1.5%) and various degree of infection in 226 patients.2. When evaluated by the overall perioperative complication scoring system:1). A total of 58(17.0%) patients did not develop complication, while 283(83%) patients developed at least one complication; among them,192(56.3%) and 50(14.7%) patients developedâ… a andâ… b complications respectively,30(8.8%) patients and 6(1.8%) patients developedâ…¡a and II b complications,2(0.6%) patients developedâ…¢complications and 3(0.9%) patients developedâ…£(death) complications.2). Among 158 cases of pancreatic fistula patients,97 (61.4%) and 38 patients (24.9%) belonged to I a and I b respectively; 15(9.7%) and 4(2.6%) patients was gradeâ…¡a andâ…¡b respectively. Gradeâ…¢a andâ…£occurred in 1(0.6%) and 3(1.9%) patients respectively. 3). Delayed gastric emptying occurred in 35 patients. The complication grade of 29 (82.8%) and 1 patient (2.9%) was I a and I b respectively.4(11.4%) patients was grade II a. Grade of IV only observed in 1(2.9%) patient.4). Among 226 patients with infectious complication, the complication grade of 154 patients (68.1%) and 37 patients (16.4%) was I a and I b respectively; 24(10.6%) and 6(2.7%) patients was grade II a and II b separately; Gradeâ…¢a andâ…£observed in 2(0.9%) patient and 3(1.3%) patients respectively.5). The level of pancreatic fistula closely related to the overall grade of perioperative complication (P< 0.05), while delayed gastric emptying and infectious complication negatively correlated with the overall grade of perioperative complication (P< 0.05). Meanwhile, the complication grade was associated with the frequency of complications (P< 0.05). However, there was no statistics difference between the complication grade and the pattern of pancreatic operations.3. The overall grade of complication was closely related with hospital stay, the lower the grade, the shorter the hospital stay (P< 0.05).4. The frequency of pancreatic fistula between pacreaticoduodenectomy (PD) and distal pancreatectomy was significant difference (P< 0.05).5. Pancreatic fistula was associated with infectious complication, cardiovascular accident and delayed gastric emptying (P< 0.05), but no relationship was observed with bleeding and bile leak (P> 0.05).6. The amylase value in drains on the third postoperative day and the amylase value in drains on the seventh postoperative day, the amylase activity of drainage fluid, the ratio of TB/CB were of well diagnostic value under univariant analysis. All the factors were independent risk factors of pancreatic fistula by multivariate analysis. Among these factors, the amylase value in drains on the third postoperative day was of the highest specificity.7. Both the overall grade of complication and the overall grade of pancreatic fistula were closely related with medical cost, the higher the grade, the more the hospital cost (P< 0.05).Conclusion:The ISGPS system could precisely predict the severity of complication. The higher the grade, the longer the hospital stay and the more the medical cost. Pancreatic fistula was the most important complication among the overall complications during the postoperative period... |
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