H. G. Lyu2, G. Sharma1,2, E. Brovman2, R. Urman2, J. S. Gold2,3, E. E. Whang2,3 1Dana Farber Cancer Insititute,Surgical Oncology,Boston, MA, USA 2Brigham And Women’s Hospital,Surgery,Boston, MA, USA 3VA Boston Healthcare System,Surgery,West Roxbury, MA, USA
Introduction: Pancreatic resections are associated with a significant rate of postoperative complications, some of which may require reoperation. However, to date, studies reporting the frequency, indications, and risk factors for reoperation have been limited. We hypothesized that specific demographic, clinical, operative, and postoperative characteristics would predict the need for reoperation after pancreatectomy.
Methods: We examined clinically abstracted information of patients undergoing pancreatic resections at one of the 435 U.S. hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) between January 1, 2011 and December 31, 2013. Debridements for pancreatitis and patients with missing reoperation data were excluded. Baseline, preoperative patient characteristics, index procedure characteristics, and postoperative course were retrospectively analyzed. Comparison of the cohort requiring unplanned 30-day reoperation with the cohort which did not require reoperation was performed utilizing Student’s t-test for continuous variables and Pearson’s Chi-Squared test with Yates’ continuity correction for categorical variables. All analyses were conducted using R Project for Statistical Computing, v3.1.2.
Results: Of the 15,658 patients undergoing pancreatectomy in our sample, 784 (5.0%) patients required unplanned reoperation. Reoperative patients were more likely to be male, have higher preoperative body mass index, cardiorespiratory comorbidities, lower preoperative baseline functional status and serum albumin, and higher American Society of Anesthesiologists class. Administration of neoadjuvant therapy was not significantly different between the two groups. Patients undergoing index conventional pancreaticoduodenectomy carried the highest reoperation rate (6.2%) whereas enucleation carried the lowest (2.4%) (Table.) Longer mean operative duration also predicted need for reoperation. Patients who ultimately underwent reoperation were more likely to have experienced postoperative cardiac, respiratory, thromboembolic, and infectious events. The rate of transfusion-requirement was more than 2-fold among patients who subsequently required reoperation. 100% of reoperations occurred during the index hospitalization, and total length of stay was more than double in the reoperative group (Table.)
Conclusion: Demographic characteristics, BMI, comorbid conditions, procedure type and duration, and postoperative events predict unplanned 30-day reoperation after pancreatectomy in the largest and most diverse sample to date. These findings identify at-risk patients; further study is required to identify preoperative measures to mitigate the risk of reoperation.
