Timing of elective surgery as a perioperative outcome variable: Analysis of pancreaticoduodenectomy Journal Article


Authors: Araujo, R. L. C.; Karkar, A. M.; Allen, P. J.; Gonen, M.; Chou, J. F.; Brennan, M. F.; Blumgart, L. H.; D'Angelica, M. I.; DeMatteo, R. P.; Coit, D. G.; Fong, Y.; Jarnagin, W. R.
Article Title: Timing of elective surgery as a perioperative outcome variable: Analysis of pancreaticoduodenectomy
Abstract: Objectives: 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. Methods: 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. Results: 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. Conclusions: Perioperative outcome after PD is determined by patient, disease and operative factors and does not appear to be influenced by procedure timing. © 2013 International Hepato-Pancreato-Biliary Association.
Journal Title: HPB
Volume: 16
Issue: 3
ISSN: 1365-182X
Publisher: Elsevier Science, Inc.  
Date Published: 2014-03-01
Start Page: 250
End Page: 262
Language: English
DOI: 10.1111/hpb.12107
PROVIDER: scopus
PMCID: PMC3945851
PUBMED: 23600897
DOI/URL:
Notes: Cited By (since 1996):1 -- Export Date: 2 April 2014 -- CODEN: HPBIF -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    331 Chou
  2. Murray F Brennan
    1059 Brennan
  3. Leslie H Blumgart
    352 Blumgart
  4. Ronald P DeMatteo
    637 DeMatteo
  5. Mithat Gonen
    1029 Gonen
  6. Peter Allen
    501 Allen
  7. William R Jarnagin
    904 Jarnagin
  8. Yuman Fong
    775 Fong
  9. Daniel Coit
    542 Coit
  10. Ami Karkar
    6 Karkar