Analysis Of Risk Factors For Perioperative Death After Pancreaticoduodenectomy

ObjectiveTo analyze the risk factors for perioperative death after pancreaticoduodenectomy.MethodsA total of 960 cases undergoing pancreaticoduodenectomy(PD)at the First Affiliated Hospital of Zhejiang University from January 2013 to January 2018 were analyzed retrospectively.Firstly,we collected relevant clinical indicators of all patients included:1.preoperative general characteristics:age,sex,height,weight,body mass index(BMI),comorbidities,and related tests;2.intraoperative data:duration of surgery,the amount of bleeding,whether there is resection combined with other organs in the surgery,whether there is revascularization in the surgery,the location of the tumor,the diameter of the tumor.3.postoperative data:postoperative pathology,lymph node metastasis,pancreatic fistula,biliary fistula,abdominal infection,postoperative bleeding,incision complications,lung infections,and delayed gastric emptying(DGE).Secondly,the univariate analysis of the 25 factors that may affect perioperative mortality after PD was performed.Finally,we made the multivariate logistic regression analysis for these statistically significant variables variables and analyzed the independent risk factors for perioperative death.The statistical analysis of data was completed by SPSS23.0,P<0.05 means that the difference was statistically significant.ResultsOf the 960 patients undergoing PD,503 suffered one or more surgical-related complications,with a total incidence of 52.4%.Thirty-six patients were died after PD,and the perioperative mortality was 3.75%.Of these cases,14 died of abdominal hemorrhage,7 died of severe abdominal infection,2 died of digestive tract bleeding,5 died of digestive fistula,3 died of acute respiratory distress syndrome(ARDS),3 died of multiple organ dysfunction syndrome(MODS),1 died of liver failure,and 1 died of renal failure.Univariate analysis showed that BMI(P=0.036),preoperative carbohydrate antigen 199(CA199)(P=0.044),preoperative albumin(ALB)(P=0.028),age>65 years(P=0.019),and intraoperative revascularization(P=0.049),intraoperatively combined with other organ resections(P=0.044),pancreatic fistula(P<0.001),biliary fistula(P<0.001),abdominal infection(P<0.001),postoperative bleeding(P<0.001),incision complications(P<0.001)and pulmonary infections(P<0.001)were closely related to perioperative mortality after PD.Multivariate logistic regression analysis showed that postoperative bleeding(P<0·001,OR=44.105),abdominal infection(P=0.011,OR=4.993),preoperative CA199>1213.95 U/ml(P=0.017,OR=3.591),Preoperative ALB<36.35 g/L(P=0.015,OR=3.453),age>65 years old(P=0.017,OR=3.411),BMI>21.24 kg/m2(P=0.034,OR=2.927)were independent risk factors for perioperative death after PD.ConclusionsPerioperative death after PD is the result of multiple factors.Postoperative bleeding,abdominal infection,preoperative CA199>1213.95 U/ml,preoperative ALB<36.35 g/L,age>65 years,and BMI>21.24 kg/m2 were independent risk factors for perioperative death after PD.