Skip to main content
SpringerLink
Log in

Risk Factors of Reoperation After Pancreatic Resection

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Pancreatic resection is associated with a high incidence of postoperative complications, some of which require reoperation.

Aims

To analyze the incidence of and risk factors for reoperation following pancreatectomy.

Methods

Pre- and postoperative information and procedure characteristics of 15,549 patients having undergone pancreatectomy in 435 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2014 were analyzed.

Results

A total of 773 (5.0%) patients required reoperation within 30 days of their index pancreatectomy. Patients requiring reoperation were more likely to be younger (mean ± standard deviation, 62.6 ± 13.2 vs. 64.1 ± 12.2 years, p < 0.001), male (60 vs. 49%, p < 0.001), to have respiratory comorbidities, lower preoperative serum albumin (3.7 ± 0.68 vs. 3.8 ± 0.62 mg/dl, p < 0.001), higher total bilirubin (1.7 ± 2.7 vs. 1.5 ± 2.4 mg/dl, p = 0.02), and higher American Society of Anesthesiologists (ASA) class than those who did not undergo reoperation. Other factors associated with increased incidence of reoperation included longer mean operative duration at the index procedure, postoperative transfusion requirement, wound complications, and cardiorespiratory, renal, thromboembolic, and infectious events. Multivariate regression analysis identified male sex, preoperative serum albumin <3.5 mg/dl, ASA class of 3 or 4, pancreaticoduodenectomy, and total pancreatectomy as the strongest predictors for reoperation after index pancreatic resection. Complication and readmission rates were significantly higher for those undergoing reoperation.

Conclusion

Patient characteristics and procedural factors contribute to reoperation after pancreatectomy in this largest and most diverse sample to date. Further investigation to identify perioperative strategies for mitigating this risk is required to improve the safety of pancreatic resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Reddy JR, Saxena R, Singh RK, et al. Reoperation following pancreaticoduodenectomy. Int J Surg Oncol. 2012.

  2. Kent TS, Sachs TE, Callery MP, Vollmer CM Jr. Readmission after major pancreatic resection: a necessary evil? J Am Coll Surg. 2011;213:515–523.

    Article  PubMed  Google Scholar 

  3. Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med. 2013;369:1134–1142.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Birkmeyer JD, Hamby LS, Birkmeyer CM, Decker MV, Karon NM, Dow RW. Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg. 2001;136:405–411.

    Article  CAS  PubMed  Google Scholar 

  5. Cunningham JD, Weyant MT, Levitt M, Brower ST, Aufses AH Jr. Complications requiring reoperation following pancreatectomy. Int J Pancreatol. 1998;24:23–29.

    CAS  PubMed  Google Scholar 

  6. Bottger T. Is pancreaticoduodenectomy with portal vein resection indicated in patients with ductal pancreatic carcinoma? Zentralbl Chir. 1999;124:220–225.

    CAS  PubMed  Google Scholar 

  7. Buchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’Graggen K. Pancreatic fistula after pancreatic head resection. Br J Surg. 2000;87:883–889.

    Article  CAS  PubMed  Google Scholar 

  8. Halloran CM, Ghaneh P, Neoptolemos JP, Costello E. Gene therapy for pancreatic cancer—current and prospective strategies. Surg Oncol. 2000;9:181–191.

    Article  CAS  PubMed  Google Scholar 

  9. Hoshal VL Jr, Benedict MB, David LR, Kulick J. Personal experience with the Whipple operation: outcomes and lessons learned. Am Surg. 2004;70:121–125. (discussion 6).

    PubMed  Google Scholar 

  10. Standop J, Glowka T, Schmitz V, et al. Operative re-intervention following pancreatic head resection: indications and outcome. J Gastrointest Surg. 2009;13:1503–1509.

    Article  PubMed  Google Scholar 

  11. Khuri SF, Daley J, Henderson W, et al. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228:491–507.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Khuri SFHW, Daley J, et al. The patient safety in surgery study: background, study design, and patient populations. J Am Coll Surg. 2007;204:1089–1102.

    Article  PubMed  Google Scholar 

  13. Khuri SF, Henderson WG, Daley J, et al. Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the patient safety in surgery study. Ann Surg. 2008;248:329–336.

    Article  PubMed  Google Scholar 

  14. Ingraham AM, Richards KE, Hall BL, et al. Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach. Adv Surg. 2010;44:251–267.

    Article  PubMed  Google Scholar 

  15. American Medical Association. CPT 2013: Current Procedural Terminology. Chicago, IL: American Medical Association; 2013.

    Google Scholar 

  16. American College of Surgeons. User guide for the 2013 ACS NSQIP participant use data file (PUF). Chicago, IL: American College of Surgeons; 2014.

    Google Scholar 

  17. Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217:833–842.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ahmad SA, Edwards MJ, Sutton JM, et al. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg. 2012;256:529–537.

    Article  PubMed  Google Scholar 

  19. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–1428.

    Article  CAS  PubMed  Google Scholar 

  20. Standop J, Glowka T, Schmitz V, et al. Operatie reintervention following pancreatic head resection: indications and outcome. J Gastrointest Surg. 2009;13:1503–1509.

    Article  PubMed  Google Scholar 

  21. Guevara OA, Rubio-Romero JA, Ruiz-Parra AI. Unplanned reoperations: is emergency surgery a risk factor? A cohort study. J Surg Res. 2013;182:11–16.

    Article  PubMed  Google Scholar 

  22. Barbas AS, Turley RS, Mallipeddi MK, et al. Examining reoperation and readmission after hepatic surgery. J Am Coll Surg. 2013;216:915.

    Article  PubMed  Google Scholar 

  23. Ravyn D, Ravyn V, Lowney R, Ferraris V. Estimating health care cost savings from an educational intervention to prevent bleeding-related complications: the outcomes impact analysis model. J Contin Educ Health Prof. 2014;34:S41–S46.

    Article  PubMed  Google Scholar 

  24. Shukla PJ, Barreto SG, Mohandas KM, Shrikhande SV. Defining the role of surgery for complications after pancreatoduodenectomy. ANZ J Surg. 2009;79:33–37.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Jill Steinberg, Quality Program Manager, and Pebbles Ashley, Coding Specialist.

Author’s contribution

All authors made substantial contributions to the conception or design of the manuscript as well as the acquisition, analysis, or interpretation of data. All authors participated in drafting or revising the work. All authors have given final approval of the version to be published. All authors agree to be accountable for all aspects of the manuscript.

Author information

Author notes

    Authors and Affiliations

    1. Department of Surgery, Brigham and Women’s Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

      Heather G. Lyu, Gaurav Sharma, Julius Ejiofor, Jason S. Gold & Edward E. Whang

    2. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA

      Ethan Brovman & Richard D. Urman

    3. Department of Surgery, VA Boston Healthcare System, West Roxbury, MA, USA

      Jason S. Gold & Edward E. Whang

    4. Center for Perioperative Research, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA

      Heather G. Lyu, Gaurav Sharma, Ethan Brovman, Julius Ejiofor, Richard D. Urman, Jason S. Gold & Edward E. Whang

    5. Department of Medicine, VA Boston Healthcare System, West Roxbury, MA, USA

      Aparna Repaka

    6. Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, MA, USA

      Aparna Repaka

    Authors
    1. Heather G. Lyu
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Gaurav Sharma
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Ethan Brovman
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Julius Ejiofor
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Aparna Repaka
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Richard D. Urman
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Jason S. Gold
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Edward E. Whang
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Heather G. Lyu.

    Ethics declarations

    Conflict of interest

    All of the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

    Additional information

    Heather G. Lyu and Gaurav Sharma have contributed equally and should both be considered first authors.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Lyu, H.G., Sharma, G., Brovman, E. et al. Risk Factors of Reoperation After Pancreatic Resection. Dig Dis Sci 62, 1666–1675 (2017). https://doi.org/10.1007/s10620-017-4546-6

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10620-017-4546-6

    Keywords

    Search

    Navigation