Skip to main content

Advertisement

SpringerLink
Log in

Impact of pulmonary embolism on morbidity and mortality in patients undergoing pancreatic surgery

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Postoperative pulmonary embolism (PE) after pancreatic surgery is a potentially life-threatening complication. However, the magnitude of morbidity and mortality of PE is still uncertain. The present study aims to assess the incidence of PE after pancreatic surgery and analyze its impact on the outcome.

Methods

We conducted a retrospective study including all patients who underwent pancreatic resections between 2005 and 2017. The development of PE was analyzed for a 90-day period following surgery. Risk factors were evaluated using regression models.

Results

The study investigated 947 patients undergoing pancreatic surgery. Overall, 26 (2.7%) patients developed PE. The median body mass index (BMI) of patients with PE was significantly higher (28.1 kg/m2 [24.7–31.8] vs. 24.8 kg/m2 [22.4–27.8], p < 0.001). Patients with PE had a significantly increased duration of the operation and more often underwent multivisceral resections. The lowest incidence of PE was found after distal or total pancreatectomy (2%). In median, PE occurred on the fifth postoperative day (interquartile range: 3–9). Increased BMI, duration of operation, and postoperative deep venous thrombosis were found to be multivariate risk factors for the development of PE. Importantly, postoperative complications (53.8% vs. 15.1%, p < 0.001) and the 30-day mortality rate were significantly increased in the PE group (19.2% vs. 3.3%, p < 0.001).

Conclusions

Patients with increased BMI, a history of deep venous thrombosis, and multivisceral resections are a high-risk group for PE after pancreatic surgery. While the absolute incidence and related mortality of PE after pancreatic surgery is low, it is associated with severe sequelae.

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

Data Availability

Not applicable.

References

  1. DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244(6):931–937 discussion 937–939

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kamphues C, Bova R, Schricke D et al (2012) Postoperative complications deteriorate long-term outcome in pancreatic cancer patients. Ann Surg Oncol 19(3):856–863

    Article  PubMed  Google Scholar 

  3. Hata T, Motoi F, Ishida M et al (2016) Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis. Ann Surg 263(4):664–672

    Article  PubMed  Google Scholar 

  4. Hartwig W, Hackert T, Hinz U et al (2009) Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 250(1):81–87

    Article  PubMed  Google Scholar 

  5. Anderson FA Jr, Spencer FA (2003) Risk factors for venous thromboembolism. Circulation 107(23 Suppl 1):l9–l16

    Google Scholar 

  6. Lindblad B, Sternby NH, Bergqvist D (1991) Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ. 302(6778):709–711

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Alikhan R, Peters F, Wilmott R et al (2004) Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol 57(12):1254–1257

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Barber EL, Clarke-Pearson DL (2017) Prevention of venous thromboembolism in gynecologic oncology surgery. Gynecol Oncol 144(2):420–427

    Article  PubMed  Google Scholar 

  9. Furie B, Furie BC (2008) Mechanisms of thrombus formation. N Engl J Med 359(9):938–949

    Article  CAS  PubMed  Google Scholar 

  10. Hwang HK, Kim H, Kang CM et al (2012) Serous cyst adenoma of the pancreas: appraisal of active surgical strategy before it causes problems. Surg Endosc 26(6):1560–1565

    Article  PubMed  Google Scholar 

  11. Bergqvist D (2006) Venous thromboembolism: a review of risk and prevention in colorectal surgery patients. Dis Colon Rectum 49(10):1620–1628

    Article  PubMed  Google Scholar 

  12. Qadan M, Polk HC Jr, Hohmann SF et al (2011) A reassessment of needs and practice patterns in pharmacologic prophylaxis of venous thromboembolism following elective major surgery. Ann Surg 253(2):215–220

    Article  PubMed  Google Scholar 

  13. Agnelli G, Bolis G, Capussotti L et al (2006) A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg 243(1):89–95

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nguyen NT, Hinojosa MW, Fayad C et al (2007) Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg 246(6):1021–1027

    Article  PubMed  Google Scholar 

  15. Molena D, Mungo B, Stem M et al (2015) Prevalence, impact, and risk factors for hospital-acquired conditions after major surgical resection for cancer: a NSQIP analysis. J Gastrointest Surg 19(1):142–151 discussion 151

    Article  PubMed  Google Scholar 

  16. Tzeng CW, Katz MH, Lee JE et al (2014) Predicting the risks of venous thromboembolism versus post-pancreatectomy haemorrhage: analysis of 13,771 NSQIP patients. HPB 16(4):373–383

    Article  PubMed  Google Scholar 

  17. Ramanathan R, Mason T, Wolfe LG et al (2018) Predictors of short-term readmission after pancreaticoduodenectomy. J Gastrointest Surg 22(6):998–1006

    Article  PubMed  Google Scholar 

  18. Simons JP, Shah SA, Ng SC et al (2009) National complication rates after pancreatectomy: beyond mere mortality. J Gastrointest Surg 13(10):1798–1805

    Article  PubMed  Google Scholar 

  19. Mukherjee D, Lidor AO, Chu KM et al (2008) Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations. J Gastrointest Surg 12(11):2015–2022

    Article  PubMed  Google Scholar 

  20. Haigh PI, Bilimoria KY, DiFronzo LA (2011) Early postoperative outcomes after pancreaticoduodenectomy in the elderly. Arch Surg (Chicago, Ill: 1960) 146(6):715–723

    Article  CAS  Google Scholar 

  21. Kruger S, Haas M, Burkl C et al (2017) Incidence, outcome and risk stratification tools for venous thromboembolism in advanced pancreatic cancer - a retrospective cohort study. Thromb Res 157:9–15

    Article  CAS  PubMed  Google Scholar 

  22. Pelzer U, Opitz B, Deutschinoff G et al (2002) Efficacy of prophylactic low-molecular weight heparin for ambulatory patients with advanced pancreatic cancer: outcomes from the CONKO-004 trial. J Clin Oncol 33(18):2028–2034

    Article  CAS  Google Scholar 

  23. Shaib W, Deng Y, Zilterman D et al (2010) Assessing risk and mortality of venous thromboembolism in pancreatic cancer patients. Anticancer Res 30(10):4261–4264

    PubMed  Google Scholar 

  24. Ishigaki K, Nakai Y, Isayama H et al (2017) Thromboembolisms in advanced pancreatic cancer: a retrospective analysis of 475 patients. Pancreas. 46(8):1069–1075

    Article  PubMed  Google Scholar 

  25. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 142(5):761–768

    Article  PubMed  Google Scholar 

  27. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 161(3):584–591

    Article  PubMed  Google Scholar 

  28. Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 142(1):20–25

    Article  PubMed  Google Scholar 

  29. Wolk S, Linke S, Bogner A et al (2019) Use of activity tracking in major visceral surgery-the enhanced perioperative mobilization trial: a randomized controlled trial. J Gastrointest Surg 23(6):1218–1226

    Article  PubMed  Google Scholar 

  30. Wolk S, Distler M, Müssle B et al (2016) Adherence to ERAS elements in major visceral surgery-an observational pilot study. Langenbeck’s Arch Surg 401(3):349–356

    Article  Google Scholar 

  31. Qanadli SD, El Hajjam M, Vieillard-Baron A et al (2001) New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol 176(6):1415–1420

    Article  CAS  PubMed  Google Scholar 

  32. Prandoni P, Falanga A, Piccioli A (2005) Cancer and venous thromboembolism. Lancet Oncol 6(6):401–410

    Article  PubMed  Google Scholar 

  33. Caprini JA (2009) Intermittent pneumatic compression and pharmacologic thrombosis prophylaxis. Curr Opin Pulm Med 15(5):439–442

    Article  PubMed  Google Scholar 

  34. Parry K, Sadeghi AH, van der Horst S et al (2017) Intermittent pneumatic compression in combination with low-molecular weight heparin in the prevention of venous thromboembolic events in esophageal cancer surgery. J Surg Oncol 115(2):181–185

    Article  PubMed  Google Scholar 

  35. Borly L, Wille-Jørgensen P, Rasmussen MS (2005) Systematic review of thromboprophylaxis in colorectal surgery -- an update. Color Dis 7(2):122–127

    Article  CAS  Google Scholar 

  36. Kokudo T, Uldry E, Demartines N et al (2014) Pulmonary embolism: specific risk factor after pancreas resection? Pancreas. 43(6):891–894

    Article  PubMed  Google Scholar 

  37. Boone BA, Zenati MS, Rieser C et al (2019) Risk of venous thromboembolism for patients with pancreatic ductal adenocarcinoma undergoing preoperative chemotherapy followed by surgical resection. Ann Surg Oncol 26(5):1503–1511

    Article  PubMed  Google Scholar 

  38. Hwang IK, Kang BK, Lee YS et al (2015) Postoperative early thromboembolism as a prognostic indicator in patients with curatively resected pancreatic cancer. Am J Surg 210(5):871–877

    Article  PubMed  Google Scholar 

  39. Oh SY, Kim JH, Lee KW et al (2008) Venous thromboembolism in patients with pancreatic adenocarcinoma: lower incidence in Asian ethnicity. Thromb Res 122(4):485–490

    Article  CAS  PubMed  Google Scholar 

  40. White RH, Zhou H, Romano PS (1998) Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California. Ann Intern Med 128(9):737–740

    Article  CAS  PubMed  Google Scholar 

  41. Stein PD, Kayali F, Olson RE et al (2004) Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census. Am J Med 116(7):435–442

    Article  PubMed  Google Scholar 

  42. Horsted F, West J, Grainge MJ (2012) Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med 9(7):e1001275

    Article  PubMed  PubMed Central  Google Scholar 

  43. Yhim HY, Jang MJ, Kwak JY et al (2013) The incidence, risk factors, and prognosis of recurrent venous thromboembolism (VTE) in patients with advanced solid cancers receiving anticoagulation therapy after the diagnosis of index VTE. Thromb Res 131(4):e133–e140

    Article  CAS  PubMed  Google Scholar 

  44. Williams TK, Rosato EL, Kennedy EP et al (2009) Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg 208(2):210–217

    Article  PubMed  Google Scholar 

  45. Ramsey AM, Martin RC (2011) Body mass index and outcomes from pancreatic resection: a review and meta-analysis. J Gastrointest Surg 15(9):1633–1642

    Article  PubMed  Google Scholar 

  46. Gilsdorf RB, Spanos P (1973) Factors influencing morbidity and mortality in pancreaticoduodenectomy. Ann Surg 177(3):332–337

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Bakkevold KE, Kambestad B (1993) Morbidity and mortality after radical and palliative pancreatic cancer surgery. Risk factors influencing the short-term results. Ann Surg 217(4):356–368

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Code availability

Not applicable.

Author information

Author notes

  1. Benjamin Müssle and Nathalie Buck contributed equally to this work.

Authors and Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, P.O. Box 01307, Dresden, Germany

    Benjamin Müssle, Nathalie Buck, Stephanie Schade, Marian Sommer, Florian Oehme, Andreas Bogner, Sebastian Hempel, Christoph Kahlert, Marius Distler, Jürgen Weitz & Thilo Welsch

  2. Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, P.O. Box 01307, Dresden, Germany

    Christoph Radosa

Authors
  1. Benjamin Müssle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathalie Buck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie Schade
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marian Sommer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Florian Oehme
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas Bogner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sebastian Hempel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christoph Radosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christoph Kahlert
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marius Distler
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jürgen Weitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Thilo Welsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: TW, BM, JW. Acquisition of data: BM, NB, SS, MS, FO, AB, SH, CR. Analysis and interpretation of data: BM, NB, FO, CR, CK, TW, MD, JW. Drafting of the manuscript: BM, NB, CK, MD, JW, TW. Critical revision of the manuscript: TW, MD, JW

Corresponding author

Correspondence to Thilo Welsch.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board at the Technische Universität Dresden (decision number: EK295072017).

Competing interests

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Previous publication

None of the information, neither in part nor the complete manuscript, has been published elsewhere. This manuscript is furthermore neither in part nor as complete manuscript under consideration for publication in any other journal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Müssle, B., Buck, N., Schade, S. et al. Impact of pulmonary embolism on morbidity and mortality in patients undergoing pancreatic surgery. Langenbecks Arch Surg 406, 893–902 (2021). https://doi.org/10.1007/s00423-020-02009-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-020-02009-4

Keywords

Search

Navigation