Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy: An NSQIP propensity-score matched analysis

Jennifer W. Harris, Jeremiah T. Martin, Erin Maynard, Patrick C. McGrath, Ching Wei D Tzeng

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Select patients with peri-ampullary cancers require concomitant colon resection (CR) during a pancreaticoduodenectomy (PD) for margin-negative resections. This study analysed the impact of concomitant CR on major morbidity (MM) and mortality. Methods National Surgical Quality Improvement Program (NSQIP) patients undergoing PD for peri-ampullary cancers were identified from 2005 to 2012. A 4: 1 propensity-score matched analysis isolated the impact of CR upon PD. Risk factors for 30-day MM and mortality were analysed to determine post-operative sequelae of PD+CR. Results From 10 965 PD and 159 PD+CR patients, 624 and 156, respectively, were selected for 4: 1 matched analysis. PD+CR resulted in a higher MM and mortality (50.0% and 9.0%) versus PD alone (28.8% and 2.9%, respectively, P <0.001). Multivariate analysis identified risk factors for MM after PD: concomitant CR [odds ratio (OR)-3.19, P <0.001], smoking (OR-1.92, P = 0.005), a lack of functional independence (OR-3.29, P = 0.018), cardiac disease (OR-2.39, P = 0.011), decreased albumin (per g/dl, OR-1.38, P = 0.033) and a longer operative time (versus median time, OR-1.56, P = 0.029). Independent predictors of mortality included concomitant CR (OR-3.16, P = 0.010), ventilator dependence (OR-13.87, P <0.001) and septic shock (OR-6.02, P <0.001). Conclusions CR was an independent predictor of MM and mortality after a PD. Patients requiring PD+CR should be identified pre-operatively, maximally optimized and referred to experienced surgeons at expert centres.

Original languageEnglish (US)
Pages (from-to)846-854
Number of pages9
JournalHPB
Volume17
Issue number9
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

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Propensity Score
Pancreaticoduodenectomy
Colectomy
Quality Improvement
Colon
Morbidity
Odds Ratio
Mortality
Mechanical Ventilators
Operative Time
Septic Shock
Albumins
Heart Diseases
Neoplasms
Multivariate Analysis
Smoking

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy : An NSQIP propensity-score matched analysis. / Harris, Jennifer W.; Martin, Jeremiah T.; Maynard, Erin; McGrath, Patrick C.; Tzeng, Ching Wei D.

In: HPB, Vol. 17, No. 9, 01.09.2015, p. 846-854.

Research output: Contribution to journalArticle

Harris, Jennifer W. ; Martin, Jeremiah T. ; Maynard, Erin ; McGrath, Patrick C. ; Tzeng, Ching Wei D. / Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy : An NSQIP propensity-score matched analysis. In: HPB. 2015 ; Vol. 17, No. 9. pp. 846-854.
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abstract = "Background Select patients with peri-ampullary cancers require concomitant colon resection (CR) during a pancreaticoduodenectomy (PD) for margin-negative resections. This study analysed the impact of concomitant CR on major morbidity (MM) and mortality. Methods National Surgical Quality Improvement Program (NSQIP) patients undergoing PD for peri-ampullary cancers were identified from 2005 to 2012. A 4: 1 propensity-score matched analysis isolated the impact of CR upon PD. Risk factors for 30-day MM and mortality were analysed to determine post-operative sequelae of PD+CR. Results From 10 965 PD and 159 PD+CR patients, 624 and 156, respectively, were selected for 4: 1 matched analysis. PD+CR resulted in a higher MM and mortality (50.0{\%} and 9.0{\%}) versus PD alone (28.8{\%} and 2.9{\%}, respectively, P <0.001). Multivariate analysis identified risk factors for MM after PD: concomitant CR [odds ratio (OR)-3.19, P <0.001], smoking (OR-1.92, P = 0.005), a lack of functional independence (OR-3.29, P = 0.018), cardiac disease (OR-2.39, P = 0.011), decreased albumin (per g/dl, OR-1.38, P = 0.033) and a longer operative time (versus median time, OR-1.56, P = 0.029). Independent predictors of mortality included concomitant CR (OR-3.16, P = 0.010), ventilator dependence (OR-13.87, P <0.001) and septic shock (OR-6.02, P <0.001). Conclusions CR was an independent predictor of MM and mortality after a PD. Patients requiring PD+CR should be identified pre-operatively, maximally optimized and referred to experienced surgeons at expert centres.",
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T1 - Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy

T2 - An NSQIP propensity-score matched analysis

AU - Harris, Jennifer W.

AU - Martin, Jeremiah T.

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AU - McGrath, Patrick C.

AU - Tzeng, Ching Wei D

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N2 - Background Select patients with peri-ampullary cancers require concomitant colon resection (CR) during a pancreaticoduodenectomy (PD) for margin-negative resections. This study analysed the impact of concomitant CR on major morbidity (MM) and mortality. Methods National Surgical Quality Improvement Program (NSQIP) patients undergoing PD for peri-ampullary cancers were identified from 2005 to 2012. A 4: 1 propensity-score matched analysis isolated the impact of CR upon PD. Risk factors for 30-day MM and mortality were analysed to determine post-operative sequelae of PD+CR. Results From 10 965 PD and 159 PD+CR patients, 624 and 156, respectively, were selected for 4: 1 matched analysis. PD+CR resulted in a higher MM and mortality (50.0% and 9.0%) versus PD alone (28.8% and 2.9%, respectively, P <0.001). Multivariate analysis identified risk factors for MM after PD: concomitant CR [odds ratio (OR)-3.19, P <0.001], smoking (OR-1.92, P = 0.005), a lack of functional independence (OR-3.29, P = 0.018), cardiac disease (OR-2.39, P = 0.011), decreased albumin (per g/dl, OR-1.38, P = 0.033) and a longer operative time (versus median time, OR-1.56, P = 0.029). Independent predictors of mortality included concomitant CR (OR-3.16, P = 0.010), ventilator dependence (OR-13.87, P <0.001) and septic shock (OR-6.02, P <0.001). Conclusions CR was an independent predictor of MM and mortality after a PD. Patients requiring PD+CR should be identified pre-operatively, maximally optimized and referred to experienced surgeons at expert centres.

AB - Background Select patients with peri-ampullary cancers require concomitant colon resection (CR) during a pancreaticoduodenectomy (PD) for margin-negative resections. This study analysed the impact of concomitant CR on major morbidity (MM) and mortality. Methods National Surgical Quality Improvement Program (NSQIP) patients undergoing PD for peri-ampullary cancers were identified from 2005 to 2012. A 4: 1 propensity-score matched analysis isolated the impact of CR upon PD. Risk factors for 30-day MM and mortality were analysed to determine post-operative sequelae of PD+CR. Results From 10 965 PD and 159 PD+CR patients, 624 and 156, respectively, were selected for 4: 1 matched analysis. PD+CR resulted in a higher MM and mortality (50.0% and 9.0%) versus PD alone (28.8% and 2.9%, respectively, P <0.001). Multivariate analysis identified risk factors for MM after PD: concomitant CR [odds ratio (OR)-3.19, P <0.001], smoking (OR-1.92, P = 0.005), a lack of functional independence (OR-3.29, P = 0.018), cardiac disease (OR-2.39, P = 0.011), decreased albumin (per g/dl, OR-1.38, P = 0.033) and a longer operative time (versus median time, OR-1.56, P = 0.029). Independent predictors of mortality included concomitant CR (OR-3.16, P = 0.010), ventilator dependence (OR-13.87, P <0.001) and septic shock (OR-6.02, P <0.001). Conclusions CR was an independent predictor of MM and mortality after a PD. Patients requiring PD+CR should be identified pre-operatively, maximally optimized and referred to experienced surgeons at expert centres.

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