Contemporary experience with postpancreatectomy hemorrhage: Results of 1,122 patients resected between 2006 and 2011 Journal Article
| Authors: | Correa-Gallego, C.; Brennan, M. F.; D'Angelica, M. I.; DeMatteo, R. P.; Fong, Y.; Kingham, T. P.; Jarnagin, W. R.; Allen, P. J. |
| Article Title: | Contemporary experience with postpancreatectomy hemorrhage: Results of 1,122 patients resected between 2006 and 2011 |
| Abstract: | Background: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication of pancreatic resection. Most published series span decades and do not reflect contemporary practice. This study analyzes the rate, management, and outcomes of PPH during a recent 5-year period. Study Design: Patients in whom PPH developed between 2006 and 2011 were identified from a prospective database. Postpancreatectomy hemorrhage was defined as evidence of bleeding associated with a drop in hemoglobin (<3 g/dL) and/or clinical signs of hemodynamic compromise, and categorized as early or late (<24 hours or >24 hours from operation). Demographics and operative and perioperative outcomes were analyzed using standard descriptive statistics. Results: Overall incidence of PPH was 3% (33 of 1,122 pancreatectomies) and was similar for pancreaticoduodenectomy (25 of 739 [3%]), distal (6 of 350 [2%]), and central pancreatectomy (2 of 31 [6%]) (p = 0.26). Early hemorrhage was seen in 21% (7 of 33) and was always extraluminal; these patients underwent reoperation and recovered fully. Late hemorrhage (26 of 33 [79%]) was predominantly intraluminal (18 of 26 [69%]), occurring at a median of 12 days postoperatively (4 to 23 days), and was treated endoscopically (13 of 26 [50%]), angiographically (10 of 26 [38%]), or surgically (3 of 26 [10%]). Postpancreatectomy hemorrhage was associated with longer hospitalization (10 [range 8 to 17] days vs 7 [range 6 to 9] days; p < 0.01); mortality, however, was not increased (1 of 33 [3%] vs 17 of 1,089 [2%]; p = 0.95). Hemorrhage began after discharge in 39% of patients (13 of 33), with the only death occurring in a patient from this group. Conclusions: Postpancreatectomy hemorrhage can be managed successfully with low mortality (3%). Early hemorrhage requires urgent reoperation, and management of delayed hemorrhage should be guided by location (intra- vs extraluminal). Greater pressure to reduce length of hospital stay appears to have increased the likelihood of PPH occurring after discharge; patients and physicians should be aware of this possibility. © 2012 American College of Surgeons. |
| Keywords: | adult; treatment outcome; aged; middle aged; retrospective studies; major clinical study; mortality; review; postoperative period; pancreas resection; outcome assessment; follow-up studies; pancreaticoduodenectomy; incidence; hemoglobin; time factors; length of stay; hospitalization; disease severity; severity of illness index; reoperation; pancreatectomy; postoperative hemorrhage; endoscopy; hemodynamics; gastrointestinal; gi; gastroduodenal artery; gda; international study group of pancreatic surgery; isgps; postpancreatectomy hemorrhage; pph; hemostatic techniques |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 215 |
| Issue: | 5 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2012-11-01 |
| Start Page: | 616 |
| End Page: | 621 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2012.07.010 |
| PROVIDER: | scopus |
| PUBMED: | 22921325 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 3 December 2012" - "CODEN: JACSE" - "Source: Scopus" |
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