Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure

Amitasha Sinha, Yuval A. Patel, Michael Cruise, Karen Matsukuma, Atif Zaheer, Elham Afghani, Dhiraj Yadav, Martin A. Makary, Kenzo Hirose, Dana Andersen, Vikesh K. Singh

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure. Methods: All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis. Results: A total of 60 patients (age 51.6 years, 53 % males) were included in our study, of whom 42 (70 %) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62 %) patients with toxic etiology, 36 (60 %) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p <0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95 % CI 1.3, 24.5, p = 0.02). Conclusion: Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 26 2016
Externally publishedYes

Fingerprint

Chronic Pancreatitis
Poisons
Pain
Pancreatic Ducts
Dilatation
Fibrosis
Smoking
Regression Analysis
Alcohols

Keywords

  • Alcohol
  • Chronic pancreatitis
  • Post-operative pain relief
  • Smoking

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure. / Sinha, Amitasha; Patel, Yuval A.; Cruise, Michael; Matsukuma, Karen; Zaheer, Atif; Afghani, Elham; Yadav, Dhiraj; Makary, Martin A.; Hirose, Kenzo; Andersen, Dana; Singh, Vikesh K.

In: Journal of Gastrointestinal Surgery, 26.01.2016, p. 1-7.

Research output: Contribution to journalArticle

Sinha, Amitasha ; Patel, Yuval A. ; Cruise, Michael ; Matsukuma, Karen ; Zaheer, Atif ; Afghani, Elham ; Yadav, Dhiraj ; Makary, Martin A. ; Hirose, Kenzo ; Andersen, Dana ; Singh, Vikesh K. / Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure. In: Journal of Gastrointestinal Surgery. 2016 ; pp. 1-7.
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abstract = "Background: Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure. Methods: All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis. Results: A total of 60 patients (age 51.6 years, 53 {\%} males) were included in our study, of whom 42 (70 {\%}) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62 {\%}) patients with toxic etiology, 36 (60 {\%}) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p <0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95 {\%} CI 1.3, 24.5, p = 0.02). Conclusion: Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.",
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AU - Sinha, Amitasha

AU - Patel, Yuval A.

AU - Cruise, Michael

AU - Matsukuma, Karen

AU - Zaheer, Atif

AU - Afghani, Elham

AU - Yadav, Dhiraj

AU - Makary, Martin A.

AU - Hirose, Kenzo

AU - Andersen, Dana

AU - Singh, Vikesh K.

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N2 - Background: Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure. Methods: All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis. Results: A total of 60 patients (age 51.6 years, 53 % males) were included in our study, of whom 42 (70 %) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62 %) patients with toxic etiology, 36 (60 %) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p <0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95 % CI 1.3, 24.5, p = 0.02). Conclusion: Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.

AB - Background: Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure. Methods: All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis. Results: A total of 60 patients (age 51.6 years, 53 % males) were included in our study, of whom 42 (70 %) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62 %) patients with toxic etiology, 36 (60 %) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p <0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95 % CI 1.3, 24.5, p = 0.02). Conclusion: Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.

KW - Alcohol

KW - Chronic pancreatitis

KW - Post-operative pain relief

KW - Smoking

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