Analysis Of Risk Factors For Perioperative Severe Complications After Pancreaticoduodenectomy

Objective To analyze the risk factors for perioperative severe complications after pancreaticoduodenectomy。Methods A total of 1198 patients underwent pancreatoduodenectomy at the First Affiliated Hospital of Zhejiang University from January 2013 to January 2019 were analyzed retrospectively.We collected clinical data of all cases,including: gender,age,height,weight,history of hypertension,history of diabetes,history of coronary heart disease,preoperative serum bilirubin level,preoperative serum albumin level,preoperative fasting blood glucose level,surgery Duration,intraoperative blood loss,location of the mass,size of the mass(maximum diameter),nature of the mass,and lymph node metastasis.With reference to the Clavein-Dindo postoperative complications classification system,the perioperative complications after PD were divided into general complications(grade Ⅰ-Ⅱ)and severe complications(grade Ⅲ-Ⅴ).Taking the severe complications of perioperative period after PD as the outcome,the univariate analysis of the factors that may affect perioperative severe complications was performed.Finally,statistically significant observation indexes were selected for multivariate logistic regression analysis to determine the independent risk factors for perioperative severe complications after PD.Results The total perioperative complication rate of 1198 PD patients was 57.60%,the severe complications rate was 6.84%,and the perioperative mortality was 3.09%.Pancreatic fistula(P <0.001),abdominal infection(P <0.001),bile fistula(P <0.001),postoperative bleeding(P <0.001),surgical site infection(P <0.001),pulmonary infection(P <0.001))are closely related to perioperative severe complications after PD.Univariate analysis showed that preoperative CA19-9(P = 0.022),preoperative total bilirubin level(P = 0.001),surgical duration(P = 0.013),and lymph node metastasis(P = 0.013)are risk factors for severe complications after PD.Multivariate analysis showed that total bilirubin > 207.5 μmol / L(P = 0.003,OR,2.126;95% CI,1.287-3.513),CA19-9> 1198.6U / m L(P = 0.042,OR,1.768;95% CI,1.021-3.062),and operation duration> 510.5min(P = 0.003,OR,2.009;95% CI,1.259-3.204)are independent risk factors for perioperative severe complications after PD.Conclusion Perioperative severe complications after PD prolong the hospital stay of patients.Patients with pancreatic fistula,biliary fistula,abdominal infection,pulmonary infection and surgical site infection after PD are more prone to serious complications.Perioperative severe complications are the results of multiple factors,the operation time > 501.5min,CA19-9> 1198.6U / L,and total bilirubin > 207.5 μmol / L are independent risk factors for perioperative severe complications after PD.