Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factor
(2019) In HPB 21(3). p.268-274- Abstract
Background: Pancreatoduodenectomy is associated with a high risk of complications. The aim was to identify preoperative risk factors for major intraoperative bleeding. Methods: Patients registered for pancreatoduodenectomy in the Swedish National Pancreatic and Periampullary Cancer Registry, 2011 to 2016, were included. Major intraoperative bleeding was defined as ≥1000 ml. Univariable and multivariable analysis of preoperative parameters were performed. Results: In total, 1864 patients were included. The median blood loss was 600 ml, and 502 patients (27%) had registered bleeding of ≥1000 ml. Preoperative independent risk factors associated with major bleeding were male sex (p < 0.001), body mass index (BMI) ≥25 kg/m2 (p... (More)
Background: Pancreatoduodenectomy is associated with a high risk of complications. The aim was to identify preoperative risk factors for major intraoperative bleeding. Methods: Patients registered for pancreatoduodenectomy in the Swedish National Pancreatic and Periampullary Cancer Registry, 2011 to 2016, were included. Major intraoperative bleeding was defined as ≥1000 ml. Univariable and multivariable analysis of preoperative parameters were performed. Results: In total, 1864 patients were included. The median blood loss was 600 ml, and 502 patients (27%) had registered bleeding of ≥1000 ml. Preoperative independent risk factors associated with major bleeding were male sex (p < 0.001), body mass index (BMI) ≥25 kg/m2 (p < 0.001), preoperative biliary drainage (PBD) (p < 0.001), C-reactive protein (CRP) ≥12 mg/L (p = 0.006) and neo-adjuvant chemotherapy treatment (NAT) (p = 0.002). Postoperative intensive care (p < 0.001), reoperation (p = 0.035), surgical infections (p = 0.036), and bile leakage (p = 0.045) were more common in the group with major bleeding, and the 30-day mortality was higher (4.9% vs 1.6%; p < 0.001). Conclusion: Most predictive parameters for major intraoperative bleeding are not modifiable. PBD is an independent predictor for major intraoperative bleeding and to reduce the risk, patients with resectable periampullary tumors should, if possible, be subject to surgery without preoperative biliary drainage.
(Less)
- author
- Rystedt, Jenny LU ; Tingstedt, Bobby LU ; Ansorge, Christoph ; Nilsson, Johan LU and Andersson, Bodil LU
- organization
-
- Surgery (research group)
- Hepato-Pancreato-Biliary Surgery (research group)
- Thoracic Surgery
- Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences (AIBCTS) (research group)
- Heart and Lung transplantation (research group)
- Artificial Intelligence in CardioThoracic Sciences (AICTS) (research group)
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- in
- HPB
- volume
- 21
- issue
- 3
- pages
- 268 - 274
- publisher
- Elsevier
- external identifiers
-
- scopus:85054102318
- pmid:30170978
- ISSN
- 1365-182X
- DOI
- 10.1016/j.hpb.2018.07.024
- language
- English
- LU publication?
- yes
- id
- 92017f04-59a1-4db7-a7e0-5131ef980408
- date added to LUP
- 2018-10-23 09:01:33
- date last changed
- 2024-07-08 22:03:39
@article{92017f04-59a1-4db7-a7e0-5131ef980408, abstract = {{<p>Background: Pancreatoduodenectomy is associated with a high risk of complications. The aim was to identify preoperative risk factors for major intraoperative bleeding. Methods: Patients registered for pancreatoduodenectomy in the Swedish National Pancreatic and Periampullary Cancer Registry, 2011 to 2016, were included. Major intraoperative bleeding was defined as ≥1000 ml. Univariable and multivariable analysis of preoperative parameters were performed. Results: In total, 1864 patients were included. The median blood loss was 600 ml, and 502 patients (27%) had registered bleeding of ≥1000 ml. Preoperative independent risk factors associated with major bleeding were male sex (p < 0.001), body mass index (BMI) ≥25 kg/m<sup>2</sup> (p < 0.001), preoperative biliary drainage (PBD) (p < 0.001), C-reactive protein (CRP) ≥12 mg/L (p = 0.006) and neo-adjuvant chemotherapy treatment (NAT) (p = 0.002). Postoperative intensive care (p < 0.001), reoperation (p = 0.035), surgical infections (p = 0.036), and bile leakage (p = 0.045) were more common in the group with major bleeding, and the 30-day mortality was higher (4.9% vs 1.6%; p < 0.001). Conclusion: Most predictive parameters for major intraoperative bleeding are not modifiable. PBD is an independent predictor for major intraoperative bleeding and to reduce the risk, patients with resectable periampullary tumors should, if possible, be subject to surgery without preoperative biliary drainage.</p>}}, author = {{Rystedt, Jenny and Tingstedt, Bobby and Ansorge, Christoph and Nilsson, Johan and Andersson, Bodil}}, issn = {{1365-182X}}, language = {{eng}}, number = {{3}}, pages = {{268--274}}, publisher = {{Elsevier}}, series = {{HPB}}, title = {{Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factor}}, url = {{http://dx.doi.org/10.1016/j.hpb.2018.07.024}}, doi = {{10.1016/j.hpb.2018.07.024}}, volume = {{21}}, year = {{2019}}, }