Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy
Article first published online: 18 APR 2013
© 2013 International Hepato-Pancreato-Biliary Association
Volume 16, Issue 3, pages 250–262, March 2014
How to Cite
Araujo, R. L. C., Karkar, A. M., Allen, P. J., Gönen, M., Chou, J. F., Brennan, M. F., Blumgart, L. H., D'Angelica, M. I., DeMatteo, R. P., Coit, D. G., Fong, Y. and Jarnagin, W. R. (2014), Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy. HPB, 16: 250–262. doi: 10.1111/hpb.12107
- Issue published online: 19 FEB 2014
- Article first published online: 18 APR 2013
- Manuscript Accepted: 21 FEB 2013
- Manuscript Received: 5 DEC 2012
The timing of major elective operations is a potentially important but rarely examined outcome variable. This study examined elective pancreaticoduodenectomy (PD) timing as a perioperative outcome variable.
Consecutive patients submitted to PD were identified. Determinants of 90-day morbidity (prospectively graded and tracked), anastomotic leak or fistula, and mortality, including operation start time (time of day), day of week and month, were assessed in univariate and multivariate analyses. Operation start time was analysed as a continuous and a categorical variable.
Of the 819 patients identified, 405 (49.5%) experienced one or more complications (total number of events = 684); 90-day mortality was 3.5%. On multivariate analysis, predictors of any morbidity included male gender (P = 0.009) and estimated blood loss (P = 0.017). Male gender (P = 0.002), benign diagnosis (P = 0.002), presence of comorbidities (P = 0.002), American Society of Anesthesiologists (ASA) score (P = 0.025), larger tumour size (P = 0.013) and positive resection margin status (P = 0.005) were associated with the occurrence of anastomotic leak or fistula. Cardiac and pulmonary comorbidities were the only variables associated with 90-day mortality. Variables pertaining to procedure scheduling were not associated with perioperative morbidity or mortality. Operation start time was not significant when analysed as a continuous or a categorical variable, or when stratified by surgeon.
Perioperative outcome after PD is determined by patient, disease and operative factors and does not appear to be influenced by procedure timing.