K. Dukleska1, A. Felix1, S. Iyer1, G. Medina1, H. Lavu1, C. J. Yeo1, J. M. Winter1 1Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA
Introduction: Major complications remain common after pancreaticoduodenectomy (PD), and are associated with increased length of stay, cost, and hospital readmissions. We hypothesized that abnormal vital signs in the early postoperative period could predict postoperative complications.
Methods: A retrospective analysis was performed of patients undergoing PD from 2009-2014 at a single high-volume academic center. Vital sign values were collected over the first seven postoperative days and assessed as predictors of postoperative complications. A subgroup analysis was performed in patients who developed complications after postoperative day number four. Vital signs obtained prior to the complication were analyzed using univariate and multivariable regression analyses to identify abnormal values that were associated with these complications.
Results: Vital signs were available for 720 patients after PD. At least one documented complication occurred in 414 (57.7%) patients, and an infectious complication occurred in 267 (37%) patients. Complications with a Clavien score ≥ 3 occurred in 136 (19%) patients. A total of 563 patients were included in the subgroup analysis. Cutoff values for temperature and heart rate (HR) greater than 100 degrees Fahrenheit (median value, Odds Ratio (OR) 17, p<0.001) and 110 beats per minute (mean value, OR 6.3, p=0.002), respectively, proved to be the most informative predictors of infection. On multivariable regression analysis, after adjusting for other vital sign values, these thresholds remained independently associated with infectious complications (median temperature, OR 12.8, p=0.002; mean HR, OR 4.1, p=0.02) (Table 1). Moreover, mean diastolic blood pressure <58 was associated with an increased 90-day mortality (OR 21.6, p=0.006).
Conclusion: Routinely collected vital signs can be used as predictors for postoperative complications in patients after PD, and ultimately may be used to select patients for early workup and intervention for occult infection. This line of investigation may lead to improved patient outcomes and reduce cost of care.
