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Impact of Cardiac Comorbidity on Early Outcomes after Pancreatic Resection

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

In patients undergoing pancreatic resection (PR), identification of subgroups at increased risk for postoperative complications can allow focused interventions that may improve outcomes.

Study Design

Patients undergoing PR from 2005–2010 were selected from the American College of Surgeons National Surgical Quality Improvement Program database and categorized as having any history of cardiac disease (angina, congestive heart failure (CHF), myocardial infarction (MI), cardiac stent, or bypass) or as having acute cardiac disease (symptoms of CHF or angina within 30 days or MI within 6 months). These variables were utilized to examine the relationship between cardiac disease and outcomes after PR.

Results

The rate of serious complications and perioperative mortality in patients with any history of cardiac disease vs. those without was 34 vs. 24 % (p < 0.001) and 4.5 vs. 2.0 % (p < 0.001), respectively, and in patients with acute cardiac disease compared to patients without was 37 vs. 25 % (p < 0.001) and 8.6 vs. 2.2 % (p < 0.001), respectively. In multivariate analysis, the two cardiac disease variables remained associated with mortality.

Conclusions

In patients undergoing PR, cardiac disease is a significant risk factor for adverse outcomes. These observations are critical for meaningful informed consent in patients considering pancreatectomy.

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References

  1. van Heek, N. T., Kuhlmann, K. F., Scholten, R. J., de Castro, S. M., Busch, O. R., van Gulik, T. M., Obertop, H., Gouma, D. J. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 2005; 242(6): 781–90.

    Article  PubMed  Google Scholar 

  2. Gouma, D. J., van Geenen, R. C., van Gulik, T. M., de Haan, R. J., de Wit, L. T., Busch, O. R., Obertop, H. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000; 232(6): 786–95.

    Article  CAS  PubMed  Google Scholar 

  3. Millikan, K. W., Deziel, D.J., Silverstein, J.C., Kanjo, T. M., Christein, J. D., Doolas, A., Prinz, R. A., Prognostic factors associated with resectable adenocarcinoma of the head of the pancreas. Am Surg 1999; 65(7): 618–24.

    CAS  PubMed  Google Scholar 

  4. Sohn, T. A., Yeo, C. J., Cameron, J. L., Koniaris, L., Kaushal, S., Abrams, R. A., Sauter, P. K., Coleman, J., Hruban, R. H., Lillemoe, K. D. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 2000; 4(6): 567–79.

    Article  CAS  PubMed  Google Scholar 

  5. Kuhlmann, K. F., de Castro, S. M., Wesseling, J. G., ten Kate, F. J., Offerhaus, G. J., Busch, O. R., van Gulik, T. M., Obertop, H, Gouma, D. J. Surgical treatment of pancreatic adenocarcinoma; actual survival and prognostic factors in 343 patients. Eur J Cancer 2004; 40(4): 549–58.

    Article  CAS  PubMed  Google Scholar 

  6. Povoski, S. P., Karpeh, M. S., Jr., Conlon, K. C., Blumgart, L. H., Brennan, M. F. Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg 1999; 230(2): 131–42.

    Article  CAS  PubMed  Google Scholar 

  7. Buchler, M. W., Wagner, M., Schmied, B. M., Uhl, W., Friess, H., Z'Graggen, K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 2003; 138(12): 1310–5.

    Article  PubMed  Google Scholar 

  8. Conlon, K. C., Labow, D., Leung, D., Smith, A., Jarnagin, W., Coit, D.G., Merchant, N., Brennan, M. F. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 2001; 234(4):487–94.

    Article  CAS  PubMed  Google Scholar 

  9. Yeo, C. J., Cameron, J. L., Lillemoe, K. D., Sauter, P. K., Coleman, J., Sohn, T. A., Campbell, K. A., Choti, M. A. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000; 232(3): 419–29.

    Article  CAS  PubMed  Google Scholar 

  10. Kennedy, T.J., Cassera, M.A., Wolf, R.,Swanstrom, L. L., Hansen, P. D. Surgeon volume versus morbidity and cost in patients undergoing pancreaticoduodenectomy in an academic community medical center. J Gastrointest Surg; 14(12): 1990–6.

  11. Gordon, T. A., Burleyson, G. P., Tielsch, J. M., Cameron, J. L. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995; 221(1): 43–9.

    Article  CAS  PubMed  Google Scholar 

  12. Lieberman, M. D., Kilburn, H., Lindsey, M., Brennan, M. F. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995; 222(5): 638–45.

    Article  CAS  PubMed  Google Scholar 

  13. Neoptolemos, J. P., Russell, R. C., Bramhall, S., Theis, B. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg 1997; 84(10): 1370–6.

    Article  CAS  PubMed  Google Scholar 

  14. Begg, C. B., Cramer, L. D., Hoskins, W. J., Brennan, M. F. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998. 280(20): 1747–51.

    Article  CAS  PubMed  Google Scholar 

  15. Sosa, J. A., Bowman, H. M., Gordon, T. A., Bass, E. B., Yeo, C. J., Lillemoe, K. D., Pitt, H. A., Tielsch, J. M., Cameron, J. L. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998; 228(3): 429–38.

    Article  CAS  PubMed  Google Scholar 

  16. Greenblatt, D. Y., Kelly, K. J., Rajamanickam, V., Wan, Y., Hanson, T., Rettammel, R., Winslow, E. R., Cho, C. S., Weber, S. M. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 2011; 18(8): 2126–35.

    Article  PubMed  Google Scholar 

  17. ACSNSQIP. American College of Surgeons National Surgical Quality Improvement Program. 2013; Available from: http://site.acsnsqip.org/. Accessed 2013 March 13.

  18. de la Fuente, S.G., Bennett, K.M., Pappas, T.N., Scarborough, J. E. Pre- and intraoperative variables affecting early outcomes in elderly patients undergoing pancreaticoduodenectomy. HPB 2011; 13(12): 887–92.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Parikh, P., Shiloach, M., Cohen, M. E., Bilimoria, K. Y., Ko, C. Y., Hall, B. L., Pitt, H. A. Pancreatectomy risk calculator: an ACS-NSQIP resource. HPB 2010; 12(7): 488–97.

    Article  PubMed Central  PubMed  Google Scholar 

  20. DeOliveira, M.L., Winter, J.M., Schafer, M., Cunningham, S. C., Cameron, J. L., Yeo, C. J., Clavien, P. A.. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006; 244(6): 931–9.

    Article  PubMed  Google Scholar 

  21. Dimick, J. B., Pronovost, P. J., Cowan, J. A., Jr., Lipsett, P. A., Stanley, J. C., Upchurch, G. R. Jr. . Variation in postoperative complication rates after high-risk surgery in the United States. Surgery 2003; 134(4): 534–41.

    Article  PubMed  Google Scholar 

  22. Birkmeyer, J. D., Siewers, A. E., Finlayson, E. V., Stukel, T. A., Lucas, F. L., Batista, I., Welch, H. G., Wennberg, D. E. Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346(15): 1128–37.

    Article  PubMed  Google Scholar 

  23. Buchler, M. W., Friess, H., Wagner, M., Kulli, C., Wagener, V., Z'Graggen, K. Pancreatic fistula after pancreatic head resection. Br J Surg 2000; 87(7): 883–9.

    Article  CAS  PubMed  Google Scholar 

  24. Metreveli, R. E., Sahm, K., Abdel-Misih, R., Petrelli, N. J. Major pancreatic resections for suspected cancer in a community-based teaching hospital: lessons learned. J Surg Oncol 2007; 95(3): 201–6.

    Article  PubMed  Google Scholar 

  25. Wente, M. N., Bassi, C., Dervenis, C., Fingerhut, A., Gouma, D. J., Izbicki, J. R., Neoptolemos, J. P., Padbury, R. T., Sarr, M. G., Traverso, M. W., Yeo, C. J., Buchler, M. W. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142(5): 761–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin, 600 Highland Avenue, G4/700 CSC, Madison, WI, 53792, USA

    Sean M. Ronnekleiv-Kelly, David Y. Greenblatt, Chee Paul Lin, Clifford S. Cho, Emily R. Winslow & Sharon M. Weber

  2. Department of Surgery, University of California, San Diego, San Diego, CA, USA

    Kaitlyn J. Kelly

Authors
  1. Sean M. Ronnekleiv-Kelly
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  2. David Y. Greenblatt
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  3. Chee Paul Lin
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  4. Kaitlyn J. Kelly
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  5. Clifford S. Cho
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  6. Emily R. Winslow
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  7. Sharon M. Weber
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Corresponding author

Correspondence to Sharon M. Weber.

Additional information

Presented at Pancreas Club (May 17th, 2013) in Orlando, FL

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Ronnekleiv-Kelly, S.M., Greenblatt, D.Y., Lin, C.P. et al. Impact of Cardiac Comorbidity on Early Outcomes after Pancreatic Resection. J Gastrointest Surg 18, 512–522 (2014). https://doi.org/10.1007/s11605-013-2399-7

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  • DOI: https://doi.org/10.1007/s11605-013-2399-7

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