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Rescue following pancreaticoduodenectomy: a multi-center observational population-based analysis
ePoster Abstracts pancreatic resection were pulmonary, gastrointestinal, and bleeding (Table 1). The complications with the greatest average percent effect on treatment-related costs were neurologic, deep vein thrombosis/pulmonary embolus (DVT/PE), and bleeding. After combining the ranks of complication frequency and percent of effect on cost, pulmonary, gastrointestinal, infectious, cardiac, and DVT/PE related complications had the greatest cumulative effect on cost related to pancreatic resection. Conclusion: Financially significant complications following pancreatic resection stem from a range of postoperative factors. Efforts focused on improving postoperative pulmonary toilet, intravenous fluid administration, and early mobilization, minimizing narcotic utilization, and minimizing sources of infection can help improve cost-effectiveness of pancreatic resection.
S139
analysis of pancreatic cancer patients surviving >90 days after surgery (N = 1886) was performed using Kaplane Meier methods. Survival of patients requiring rescue was compared to those who did not undergo postoperative interventions using the log-rank test. Results: Of 2563 PD patients, 119 died within 90 days of surgery (4.6%). 779 experienced at least one postoperative intervention during the 90-day postoperative period, of these, 728 (93.5%) survived (rescued), and 51 (6.5%) died within 90 days of surgery. Of the 1784 patients not undergoing postoperative drain insertion or reoperation, 68 died within 90 days of surgery (3.8%). Pancreatic cancer patients who experienced postoperative interventions and were rescued had similar long-term survival as those who did not (2.2 years, 95% CI: 2.0e2.5, versus 2.4 years, 95% CI: 2.2e2.6, respectively, p=0.14).
Table 1 Most frequent and financially significant complications following pancreatic resection.
Complication group
Percent
Rank of frequency
Average effect on cost (%)
Rank of effect on cost
Combined rank
Pulmonary
31.31
1
0.25
3
4
Gastrointestinal
23.86
2
0.20
4
6
Infectious
15.50
4
0.15
6
10
Cardiac
10.47
5
0.17
5
10
Deep vein thrombosis/ pulmonary embolus
1.41
8
0.32
2
10
Bleeding
15.69
3
0.12
8
11
Neurologic
0.64
11
0.41
1
12
Renal
5.27
7
0.13
7
14
Iatrogenic
8.89
6
0.01
11
17
Hepatic
0.83
10
0.03
9
19
Psychiatric
1.12
9
0.02
10
19
P49 RESCUE FOLLOWING PANCREATICODUODENECTOMY: A MULTI-CENTER OBSERVATIONAL POPULATION-BASED ANALYSIS
Conclusion: The vast majority of patients requiring postoperative invasive abdominal procedures survive the 90day postoperative period, and experience similar long-term survival as patients not undergoing these interventions.
D. Kagedan, N. Goyert, P. Karanicolas, A. Wei, Q. Li, C. Earle, L. Paszat, A. Kiss, N. Mittmann and N. Coburn Sunnybrook Health Sciences Centre, Toronto, Canada Objective: Rescue after surgery denotes patients who survive postoperative complications. We sought to measure short- and long-term survival among patients undergoing pancreaticoduodenectomy (PD) with a subsequent drain placement or reoperation (rescued). Methods: A retrospective population-based observational cohort study was performed. Patients undergoing PD between 2005 and 2013 were identified and linked to administrative healthcare databases (N = 2660). Patients undergoing PD at institutions performing <10 PDs/year were excluded (N = 97). Patients that had postoperative abdominal drain placement or reoperation were defined as having postoperative complications. 90-day survival rates following PD were observed. Patients experiencing postoperative interventions who survived 90 days following surgery were defined as rescued. Landmark survival
P50 MICROBIOLOGY AND COMPLICATIONS IN DUODENOPANCREATECTOMY: THE IMPLICATIONS OF PRE-OPERATIVE ERCP
HPB 2017, 19 (S1), S120eS192
T. Costa, T. Ribeiro, R. Jureidini, G. Namur, E. Figueira, T. Bacchella and I. Cecconello Hospital das Clinicas de Sao Paolo, Sao Paulo, Brazil Objective: Patients undergoing pancreatoduodenectomy at the clinics hospital of the University of Sao Paulo between January/2009 and September/2014 were retrospectively reviewed. Methods: We evaluated etiology and the impact of bile culture positivity on development of post-operative complications. Patients were divided into groups according to results of intraoperative bile culture and ECRP with prosthesis before the surgery.
S139
analysis of pancreatic cancer patients surviving >90 days after surgery (N = 1886) was performed using Kaplane Meier methods. Survival of patients requiring rescue was compared to those who did not undergo postoperative interventions using the log-rank test. Results: Of 2563 PD patients, 119 died within 90 days of surgery (4.6%). 779 experienced at least one postoperative intervention during the 90-day postoperative period, of these, 728 (93.5%) survived (rescued), and 51 (6.5%) died within 90 days of surgery. Of the 1784 patients not undergoing postoperative drain insertion or reoperation, 68 died within 90 days of surgery (3.8%). Pancreatic cancer patients who experienced postoperative interventions and were rescued had similar long-term survival as those who did not (2.2 years, 95% CI: 2.0e2.5, versus 2.4 years, 95% CI: 2.2e2.6, respectively, p=0.14).
Table 1 Most frequent and financially significant complications following pancreatic resection.
Complication group
Percent
Rank of frequency
Average effect on cost (%)
Rank of effect on cost
Combined rank
Pulmonary
31.31
1
0.25
3
4
Gastrointestinal
23.86
2
0.20
4
6
Infectious
15.50
4
0.15
6
10
Cardiac
10.47
5
0.17
5
10
Deep vein thrombosis/ pulmonary embolus
1.41
8
0.32
2
10
Bleeding
15.69
3
0.12
8
11
Neurologic
0.64
11
0.41
1
12
Renal
5.27
7
0.13
7
14
Iatrogenic
8.89
6
0.01
11
17
Hepatic
0.83
10
0.03
9
19
Psychiatric
1.12
9
0.02
10
19
P49 RESCUE FOLLOWING PANCREATICODUODENECTOMY: A MULTI-CENTER OBSERVATIONAL POPULATION-BASED ANALYSIS
Conclusion: The vast majority of patients requiring postoperative invasive abdominal procedures survive the 90day postoperative period, and experience similar long-term survival as patients not undergoing these interventions.
D. Kagedan, N. Goyert, P. Karanicolas, A. Wei, Q. Li, C. Earle, L. Paszat, A. Kiss, N. Mittmann and N. Coburn Sunnybrook Health Sciences Centre, Toronto, Canada Objective: Rescue after surgery denotes patients who survive postoperative complications. We sought to measure short- and long-term survival among patients undergoing pancreaticoduodenectomy (PD) with a subsequent drain placement or reoperation (rescued). Methods: A retrospective population-based observational cohort study was performed. Patients undergoing PD between 2005 and 2013 were identified and linked to administrative healthcare databases (N = 2660). Patients undergoing PD at institutions performing <10 PDs/year were excluded (N = 97). Patients that had postoperative abdominal drain placement or reoperation were defined as having postoperative complications. 90-day survival rates following PD were observed. Patients experiencing postoperative interventions who survived 90 days following surgery were defined as rescued. Landmark survival
P50 MICROBIOLOGY AND COMPLICATIONS IN DUODENOPANCREATECTOMY: THE IMPLICATIONS OF PRE-OPERATIVE ERCP
HPB 2017, 19 (S1), S120eS192
T. Costa, T. Ribeiro, R. Jureidini, G. Namur, E. Figueira, T. Bacchella and I. Cecconello Hospital das Clinicas de Sao Paolo, Sao Paulo, Brazil Objective: Patients undergoing pancreatoduodenectomy at the clinics hospital of the University of Sao Paulo between January/2009 and September/2014 were retrospectively reviewed. Methods: We evaluated etiology and the impact of bile culture positivity on development of post-operative complications. Patients were divided into groups according to results of intraoperative bile culture and ECRP with prosthesis before the surgery.