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Serum Blood Urea Nitrogen and Serum Albumin on the First Postoperative Day Predict Pancreatic Fistula and Major Complications After Pancreaticoduodenectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Pancreaticoduodenectomy (PD) has a high morbidity rate. Previous work has shown that hypoalbuminemia on postoperative day 1 (POD) to be contributory to post-esophagectomy complications. We set out to determine the impact of blood urea nitrogen (BUN) and albumin on POD 1 for patients undergoing PD.

Methods

We examined 446 consecutive patients who underwent PD at the Thomas Jefferson University Hospital between January 1, 2000 and December 31, 2008. Complications were graded using the Clavien scale. We examined the incidence of complications based on POD 1 albumin <2.5 versus ≥2.5 mg/dl, as well as POD 1 BUN <10 vs. ≥10 g/dL.

Results

Patients with a BUN <10 had a significantly decreased risk of any complication (p < 0.001), serious complication (p < 0.001), and pancreatic fistula (p = 0.011). On multivariate analysis, BUN ≥ 10 was the most significant predictor of grade III or above complication (p = 0.0019, hazard ration (HR) = 2.7) and pancreatic fistula (p = 0.016, HR = 2.6). POD 1 albumin <2.5 mg/dl was also an independent predictor of serious complication (p = 0.01, HR = 2.3). Patients with both risk factors had a 31 % chance of developing serious complications and 18.5 % risk of developing pancreatic fistula, while those patients with neither risk factor had a 6.5 and 3.6 % risk, respectively.

Conclusion

Serum albumin and BUN on POD 1 are important predictors of perioperative morbidity following PD. These low-cost and easily accessible tests can be used as a prognostic tool to predict adverse surgical outcomes.

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References

  1. Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006;10:1199–1210; discussion 1210–1.

    Article  PubMed  Google Scholar 

  2. American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society. 2012; 2012:19.

  3. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 1995;221:721–31; discussion 731–3.

    Article  PubMed  CAS  Google Scholar 

  4. Kausch W. Das carcinom der papilla duodeni und seine radikale entfernung. Beitr Klin Chir 1912;78:439–451.

    Google Scholar 

  5. Hirschel G. Die resektion des duodenums mit der papille wegen karzinoims. Munchen Med Wochenshr 1914;61:1728–1730.

    Google Scholar 

  6. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg 1935;102:763–779.

    Article  PubMed  CAS  Google Scholar 

  7. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244:931–7; discussion 937–9.

    Article  PubMed  Google Scholar 

  8. Braasch JW, Gray BN. Considerations that lower pancreatoduodenectomy mortality. Am J Surg 1977;133:480–484.

    Article  PubMed  CAS  Google Scholar 

  9. Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000;232:786–795.

    Article  PubMed  CAS  Google Scholar 

  10. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248–57; discussion 257–60.

    Article  PubMed  CAS  Google Scholar 

  11. Bentrem DJ, Yeh JJ, Brennan MF, et al. Predictors of intensive care unit admission and related outcome for patients after pancreaticoduodenectomy. J Gastrointest Surg 2005;9:1307–1312.

    Article  PubMed  Google Scholar 

  12. Ryan AM, Hearty A, Prichard RS, et al. Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy. J Gastrointest Surg 2007;11:1355–1360.

    Article  PubMed  Google Scholar 

  13. Winter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg 2007;204:1029–36; discussion 1037–8.

    Article  PubMed  Google Scholar 

  14. Kennedy EP, Rosato EL, Sauter PK, et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution—the first step in multidisciplinary team building. J Am Coll Surg 2007;204:917–23; discussion 923–4

    Article  PubMed  Google Scholar 

  15. Chai FY, Jiffre D. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery. Ann Surg 2011;254:665; author reply 665–6.

    Article  PubMed  Google Scholar 

  16. Hennessey DB, Burke JP, Ni-Dhonochu T, et al. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 2010;252:325–329.

    Article  PubMed  Google Scholar 

  17. Rosa F, Bossola M, Pacelli F, et al. Malnutrition and postoperative complications in abdominal surgery. Ann Surg 2011;254:666; author reply 666–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    Daniel M. Relles, Nathan G. Richards, Jordan P. Bloom, Eugene P. Kennedy, Patricia K. Sauter, Ernest L. Rosato, Charles J. Yeo & Adam C. Berger

  2. Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA, USA

    Benjamin E. Leiby

  3. Jefferson Pancreas, Biliary and Related Cancer Center, Philadelphia, PA, USA

    Daniel M. Relles, Nathan G. Richards, Jordan P. Bloom, Eugene P. Kennedy, Patricia K. Sauter, Benjamin E. Leiby, Ernest L. Rosato, Charles J. Yeo & Adam C. Berger

  4. Department of Surgery, Thomas Jefferson University, 1100 Walnut Street, MOB, Suite 500, Philadelphia, PA, 19107, USA

    Adam C. Berger

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  1. Daniel M. Relles
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  2. Nathan G. Richards
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  8. Charles J. Yeo
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Correspondence to Adam C. Berger.

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Relles, D.M., Richards, N.G., Bloom, J.P. et al. Serum Blood Urea Nitrogen and Serum Albumin on the First Postoperative Day Predict Pancreatic Fistula and Major Complications After Pancreaticoduodenectomy. J Gastrointest Surg 17, 326–331 (2013). https://doi.org/10.1007/s11605-012-2093-1

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  • DOI: https://doi.org/10.1007/s11605-012-2093-1

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