Detailed Abstract
[Oral Presentation 5 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[OP 5-3] Risk factors of failure to rescue in patients with complication ≥ clavien-dindo IV following elective pancreatectomy : Tertiary referral single center retrospective study
Jimin SON1 , Ye Won JEON1 , Janghun HAN1 , Min Kyu SUNG1 , Yoo Na LEE1 , Younghoon ROH1 , Nam-ryong CHOI1 , Yejong PARK1 , Hyeyeon KIM1 , Bong Jun KWAK1 , Woohyung LEE1 , Jae Hoon LEE1 , Dae Wook HWANG1 , Song Cheol KIM1 , Suk-kyung HONG2 , Ki Byung SONG*1
1 Division Of Hepato-Biliary And Pancreas Surgery, Department Of General Surgery, Asan Medical Center, University Of Ulsan College Of Medicine, REPUBLIC OF KOREA
2 2Division Of Acute Care Surgery, Department Of General Surgery, Asan Medical Center, University Of Ulsan College Of Medicine, REPUBLIC OF KOREA
Background : Failure to rescue (FTR) means death following a complication and it has been proved to be more important factor than overall complication rates in determining mortality rates after pancreatectomy. Hospital volume was the most studied proven factor in FTR after pancreatectomy, however, there have been few studies focusing on patient factors. And as far as we know, there have been no single studies about FTR focusing on subgroup of patients with complication ≥ Clavien-dindo IV following pancreatic surgery which is likely to have distinct features.
Methods : This single-center retrospective cohort study was conducted in Seoul Asan Medical Center. We enrolled patients who required UIA following elective pancreatic surgery from January 1, 2014 to Oct 31, 2022. Those who underwent emergency surgery, were co-operated in another department, were readmitted in the hospital, underwent routine ICU admission <48 hrs after surgery, were admitted in the ICU before surgery and experienced death <48 hrs after surgery were excluded
Results : During the studied period, 7041 elective pancreatectomies were performed at the center, after excluding the patients by formetioned criteria, 126 patients (1.8%, 126/7041). 18 patients were not be able to be rescued despite critical care (14.3%, 18/126). In univariate analysis, Charlson Comorbidity Score Index (CCI) and age, were proven to be associated with FTR among preoperative factors. The APACHE IV score calculated using 24hrs data at immediate ICU admission period was higher in FTR group (95.6±27.4 vs 71.4 ±13.93, p < 0.001). In FTR group, surgical site infection without postoperative pancreatic fistula and liver failure was more frequent at pre-ICU admission period. After initial ICU admission, the rate of postpancreatectomy hemorrhage, pulmonary complication, renal failure and liver failure were higher in FTR group. In multivariate logistic regression analysis, APACHE IV score >106, complications after initial ICU admission including PPH, pulmonary complication and liver failure were proven to be an independent risk factors of FTR in the studied group.
Conclusions : In patients experienced complication ≥ Clavien-dindo IV after elective pancreatectomy, severity at ICU admission and additional complications especially PPH, pulmonary complication and liver failure afterward increased the FTR while the preoperative factors and the type of complication leading to ICU admission were not proven to be statsitically significant in this study
Methods : This single-center retrospective cohort study was conducted in Seoul Asan Medical Center. We enrolled patients who required UIA following elective pancreatic surgery from January 1, 2014 to Oct 31, 2022. Those who underwent emergency surgery, were co-operated in another department, were readmitted in the hospital, underwent routine ICU admission <48 hrs after surgery, were admitted in the ICU before surgery and experienced death <48 hrs after surgery were excluded
Results : During the studied period, 7041 elective pancreatectomies were performed at the center, after excluding the patients by formetioned criteria, 126 patients (1.8%, 126/7041). 18 patients were not be able to be rescued despite critical care (14.3%, 18/126). In univariate analysis, Charlson Comorbidity Score Index (CCI) and age, were proven to be associated with FTR among preoperative factors. The APACHE IV score calculated using 24hrs data at immediate ICU admission period was higher in FTR group (95.6±27.4 vs 71.4 ±13.93, p < 0.001). In FTR group, surgical site infection without postoperative pancreatic fistula and liver failure was more frequent at pre-ICU admission period. After initial ICU admission, the rate of postpancreatectomy hemorrhage, pulmonary complication, renal failure and liver failure were higher in FTR group. In multivariate logistic regression analysis, APACHE IV score >106, complications after initial ICU admission including PPH, pulmonary complication and liver failure were proven to be an independent risk factors of FTR in the studied group.
Conclusions : In patients experienced complication ≥ Clavien-dindo IV after elective pancreatectomy, severity at ICU admission and additional complications especially PPH, pulmonary complication and liver failure afterward increased the FTR while the preoperative factors and the type of complication leading to ICU admission were not proven to be statsitically significant in this study
SESSION
Oral Presentation 5
Room A 3/24/2023 3:50 PM - 4:40 PM