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
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
    153 Chou
  2. Murray F Brennan
    759 Brennan
  3. Leslie H Blumgart
    340 Blumgart
  4. Ronald P DeMatteo
    597 DeMatteo
  5. Mithat Gonen
    701 Gonen
  6. Peter Allen
    436 Allen
  7. William R Jarnagin
    583 Jarnagin
  8. Yuman Fong
    741 Fong
  9. Daniel Coit
    415 Coit
  10. Ami Karkar
    6 Karkar