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Risk of Morbidity and Mortality Following Hepato-Pancreato-Biliary Surgery

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Hepatic, pancreatic, and complex biliary (HPB) surgery can be associated with major morbidity and significant mortality. For the past 5 years, the American College of Surgeons–National Surgical Quality Improvement Program (ACS–NSQIP) has gathered robust data on patients undergoing HPB surgery. We sought to use the ACS–NSQIP data to determine which preoperative variables were predictive of adverse outcomes in patients undergoing HPB surgery.

Methods

Data collected from ACS–NSQIP on patients undergoing hepatic, pancreatic, or complex biliary surgery between 2005 and 2009 were analyzed (n = 13,558). Diagnoses and surgical procedures were categorized into 10 and eight groups, respectively. Seventeen preoperative clinical variables were assessed for prediction of 30-day postoperative morbidity and mortality. Multivariate logistic regression was utilized to develop a risk model.

Results

Of the 13,558 patients who underwent an HPB procedure, 7,321 (54%) had pancreatic, 4,881 (36%) hepatic, and 1,356 (10%) biliary surgery. Overall, 70.3% of patients had a cancer diagnosis. Post-operative complications occurred in 3,850 patients for an overall morbidity of 28.4%. Serious complications occurred in 2,522 (18.6%) patients; 366 patients died for an overall peri-operative mortality of 2.7%. Peri-operative outcome was associated with diagnosis and type of procedure. Hepatic trisectionectomy (5.8%) and total pancreatectomy (5.4%) had the highest 30-day mortality. Of the preoperative variables examined, age >74, dyspnea with moderate exertion, steroid use, prior cardiac procedure, ascites, and pre-operative sepsis were associated with morbidity and mortality (all P < 0.05).

Conclusions

While overall morbidity and mortality for HPB surgery are low, peri-operative outcomes are heterogeneous and depend on diagnosis, procedure type, and key clinical factors. By combining these factors, an ACS–NSQIP “HPB Risk Calculator” may be developed in the future to help better risk-stratify patients being considered for complex HPB surgery.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Harvey 611, Baltimore, MD, 21287, USA

    Peter J. Kneuertz MD & Timothy M. Pawlik MD, MPH, PhD

  2. Department of Surgery, Indiana University, Indianapolis, IN, USA

    Henry A. Pitt MD

  3. Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Karl Y. Bilimoria MD, MPH

  4. Department of Surgery, The University of California at Los Angeles, Los Angeles, CA, USA

    Clifford Y. Ko MD

  5. Department of Surgery, Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA

    Karl Y. Bilimoria MD, MPH, Jill P. Smiley PhD, Mark E. Cohen PhD & Clifford Y. Ko MD

Authors
  1. Peter J. Kneuertz MD
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  2. Henry A. Pitt MD
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  3. Karl Y. Bilimoria MD, MPH
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  4. Jill P. Smiley PhD
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  5. Mark E. Cohen PhD
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  6. Clifford Y. Ko MD
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  7. Timothy M. Pawlik MD, MPH, PhD
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Kneuertz, P.J., Pitt, H.A., Bilimoria, K.Y. et al. Risk of Morbidity and Mortality Following Hepato-Pancreato-Biliary Surgery. J Gastrointest Surg 16, 1727–1735 (2012). https://doi.org/10.1007/s11605-012-1938-y

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  • DOI: https://doi.org/10.1007/s11605-012-1938-y

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