Risk Factors For The Complications And Death After Pancreaticoduodenectomy

ObjectiveTo study the influence of these risk factors on postoperative complications and mortality after pancreaticoduodenectomy, which by retrospectively analyzing medical records of 188 patients undergone PD, so as to provide a few help for raising the safety of surgery.MethodsA retrospective review was performed of the medical records of 188 patients who underwent PD between October 2011 and October 2014, which come from Qi Lu hospital of Shan Dong University. Amongst which,there are 108 male patients(57.0%),80 female patients(43.0%), aging from 20 years old to 77 years old (57.3±10.3). The main selected risk factors:age, sex, tumor type, tumor size, lymph node metastasis, history of abdominal surgery, surgical procedure, operation time, blood loss in operation, the presence of other diseases, preoperative serum total bilirubin (TBIL), preoperative serum albumin (ALB), preoperative hemoglobin (HGB) and pancreas texture,etc. Data statistics are proeessed by SPSS19.0 software and Microsoft Office Excel.The results from single variable analysis are validated by chi-square test.We then selected factors with P values<0.10 for inclusion as factors in the multivariate analysis using stepwise Logistic regression.The factors that are kept in the Logistic regression model as defined as significant and dangerous ones which are independent as well.ResultsThe study collected the data of 188 cases of PD in total. The rates of complications of PD (high to low) are pancreatic fistula 20.7%(39/188), abdominal cavity infection 13.8%(26/188), biliary fistula 9.6%(18/188), gastric paralysis 8.5%(16/188), blade problem (infection, liquefaction, split) 8.0%(15/188), abdominal cavity hemorrhage 5.9%(11/188), gastrointestinal bleeding 2.7%(5/188), lung infection 1.6% (3/188),etc. The independent risk factors for pancreatic fistula include diabetes mellitus(OR=6.966), preoperative TBIL (≥171μmol/L) (OR=8.607), preoperative ALB (<35g/L) (OR=10.429) and the texture of pancreas (soft) (OR=4.578). The predictive formula for pancreatic fistula:P=1/[1+e-(-5.127+1.941*dibetees mellitus +2.153*preoperative TBIL (≥171μmol/L)+2.345* preoperative ALB(<35g/L)+1.521*the texture of pancreas (soft))].The independent risk factors for abdominal infection include operation hemorrhage (≥ 400ml) (OR=4.412), pancreatic fistula(OR=55.773) and biliary fistula(OR=29.791). The predictive formula for abdominal infection:P=1/[1+e*5.191+4.021*pancreatic fistula +1.484*operation hemorrhage(≥400ml)+3.394* biliary leakage)]. The independent risk factors for biliary fistula include postoperative ALB (<35g/L) (OR=5.379), diameter of common bile duct (< 1.5cm) (OR=3.013)and pancreatic fistula (OR=8.397). The predictive formula for biliary fistula:P=1/[1+e-(-4.693+1.682*postoperative ALB(<35g/L)+1.103*diameter of common bile duct(<1.5cm)+2.128*pancreatic fistula)] The independent risk factors for gastric paralysis include history of alcohol abuse(OR=3.215), diabetes (OR=4.335)and surgical procedure (PPPD) (OR=7.797). The predictive formula for gastric paralysis:P=1/ [1+e-(-4.261+1.168*history of alcohol abuse+1.467*diabetes+2.054*surgical procedure(PPPD)). The independent risk factors for abdominal bleeding include surgical bleeding (≥400ml) (OR=9.987), anastomotic fistula (OR=6.619)and preoperative hemoglobin (< 100g/L)(OR=5.860). The predictive formula for abdominal bleeding:P=1/[1+e-(-4.852 +2.301*surgical bleeding(≥400ml)+1.890*anastomotic fistula+1.768*preoperative hemoglobin(<100g/L)).The independent risk factors for early postoperative death include age(≥65) (OR=19.076), abdominal cavity infection(OR=4.971), abdominal cavity hemorrhage(OR=23.561) The predictive formula for early postoperative death:P=1/[1+e-(-5.817+1.604*abdominal cavity infection+3.160*abdominal cavity hemorrhage+2.948*age (≥65))]ConclusionThe independent risk factors for pancreatic fistula include diabetes mellitus, preoperative TBIL (≥171μmol/L), preoperative ALB (<35g/L) and the texture of pancreas (soft). The independent risk factors for abdominal infection include operation hemorrhage (≥400ml), pancreatic fistula and biliary fistula. he independent risk factors for biliary fistula include postoperative ALB (<35g/L), diameter of common bile duct (< 1.5cm) and pancreatic fistula. The independent risk factors for gastric paralysis include history of alcohol abuse, diabetes and surgical procedure (PPPD). The independent risk factors for abdominal bleeding include surgical bleeding (≥400ml), anastomotic fistula and preoperative hemoglobin (<100g/L) The independent risk factors for g early postoperative death include age(≥65), abdominal cavity infection, abdominal cavity hemorrhage. Therefore, correcting and improving physical condition of patients preoperation, careful operating intraoperation, strengthening postoperative care, can reduce the occurrence of complications patient with a certain extent.