scholarly journals Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094342
Author(s):  
Kate Nong ◽  
Yue Zhang ◽  
Shengyong Liu ◽  
Yue Yang ◽  
Donglin Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Bilirubin Level ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Amylase Level ◽  
Drainage Fluid ◽  
Soft Pancreas ◽  
Laparoscopic Pancreatoduodenectomy ◽  
Potential Risk Factors

Objective To analyse potential risk factors for postoperative pancreatic fistula (POPF). Methods A retrospective study on risk factors for POPF was conducted in patients undergoing laparoscopic pancreatoduodenectomy. Basic characteristics, and preoperative, intraoperative and postoperative patient data were collected and analysed. Results A total of 268 patients were enrolled in this study, including 54 patients with POPF following surgery (POPF incidence, 20.15%). Univariate analysis indicated that patient’s age, body mass index (BMI), preoperative bilirubin level, pancreas texture, and drainage fluid amylase level on day 1 following surgery were associated with POPF. Multiple logistic regression analysis indicated that preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25, and age ≥65 years were independent risk factors associated with POPF. Conclusions For patients with preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25 and age ≥65 years, clinically relevant measures should be taken as early as possible for the prophylaxis of POPF.

scholarly journals Total Amylase Value in Drains After Gastrectomy for Predicting Postoperative Pancreatic Fistula

2020 ◽  
Author(s):  
Toshitaka Sugawara ◽  
Hisashi Shinohara ◽  
Shusuke Haruta ◽  
Junichi Shindo ◽  
Masaki Ueno ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Concentration Ratio ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Roc Curves ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
Anastomotic Site ◽  
Drainage Fluid

Objective: Postoperative pancreatic fistula (POPF) is defined using the ratio of the bilirubin concentration in abdominal drainage fluid to the upper normal range of serum amylase level. However, we hypothesized that the total amylase value in discharge (AVD) on POD 3 may be more sensitive for predicting grade II or higher severe POPF sPOPF, and compared the predictive power of the conventional definition of POPF and AVD for sPOPF. Methods: One hundred and fifty-one patients who underwent gastrectomy between October 2011 and February 2013 were analyzed. A drainage tube was placed in all the cases through the stump of the right gastroepiploic vein and the front of the pancreas to the back of the anastomotic site. The drainage volume and amylase concentration in the discharge were examined on POD 1, 3, and 5. AVD was calculated by multiplying the volume by the amylase concentration. Results: Eight patients (5.3%) developed sPOPF. In univariate analysis, both AVD and the amylase concentration ratio was significantly correlated with sPOPF (P = 0.002 and 0.007, respectively). AVD on POD 3 showed the best predictive performance compared with the amylase concentration ratio on POD 3 (area under the curve 0.876 vs. 0.844). Based on the cutoff values calculated from the ROC curves, AVD was more specific than amylase concentration ratio in predicting sPOPF (specificity: 97.6% vs. 86.0%; PPV: 62.5% vs. 23.1%). Conclusion: AVD on POD 3 is a more specific parameter than conventional amylase concentration ratio in predicting sPOPF.

scholarly journals Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Gao Qing Wang ◽  
Dipesh Kumar Yadav ◽  
Wei Jiang ◽  
Yong Fei Hua ◽  
Cai De Lu
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Surgical Complication ◽  
Univariate Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Soft Pancreas

Objectives. Clinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discuss the risk factors of pancreatic fistula in order to interpret the clinical importance. Methods. In this retrospective study, 263 patients who underwent DP at Ningbo Medical Center Li Huili Hospital between January 2011 and January 2020 were reviewed in accordance with relevant guidelines and regulations. Patients’ demographics and clinical parameters were evaluated using univariate and multivariate analyses to identify the risk factors contributing to CR-POPF. P < 0.05 was considered statistically significant. Results. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication (19.0%). The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct were more likely to develop pancreatic fistula. However, on multivariate analysis, the soft texture of the pancreas (OR = 2.381, 95% CI = 1.271–4.460, P = 0.001 ) and the ligation of the main pancreatic duct (OR = 0.388, 95% CI = 0.207–0.726, P = 0.002 ) were only an independent influencing factor for CR-POPF. Conclusions. As a conclusion, pancreatic fistula was the most common surgical complication after DP. The soft texture of the pancreas and the absence of ligation of the main pancreatic duct can increase the risk of CR-POPF.

scholarly journals Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Experience

2020 ◽  
Author(s):  
Gao Qing Wang ◽  
Dipesh Kumar Yadav ◽  
Wei Jiang ◽  
Yong Fei Hua ◽  
Cai De Lu
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Surgical Complication ◽  
Univariate Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Soft Pancreas

AbstractClinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discussed the risk factors of pancreatic fistula in order to interpret the clinical importance. All the patients who underwent DP in between January 2011 and January 2020 were reviewed retrospectively in accordance with relevant guidelines and regulations. The univariate and multivariate analysis was performed was performed to test an independent risk factors for pancreatic fistula. P<0.05 was considered statistically significant. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication 19.0%. The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct are more likely to develop pancreatic fistula. However, on multivariate analysis the soft texture of the pancreas (OR= 2.381, P= 0.001) and the ligation of main pancreatic duct (OR= 0.388, P= 0.002) were only an independent influencing factor for CR-POPF. As a conclusion, pancreatic fistula was the most common surgical complication after DP, and the texture of pancreas and ligation of main pancreatic duct can influence an incidence of CR-POPF.

Body Mass Index is a Risk Factor of Pancreatic Fistula after Pancreaticoduodenectomy

2012 ◽  
Vol 78 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Mitsugi Shimoda ◽  
Masato Katoh ◽  
Iso Yukihiro ◽  
Junji Kita ◽  
Tokihiko Sawada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Risk Factor ◽  
Pancreatic Fistula ◽  
Body Mass ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Remnant Pancreas ◽  
Soft Pancreas

Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a severe complication and a challenging problem. The common risk factors are the soft pancreas and small pancreatic duct of the remnant pancreas. Those two risk factors were recognized during surgery. On the other hand, a preoperatively determined risk factor of PF is unclarified. We conducted a retrospective analysis of 203 patients consecutively treated by PD from April 2000 to October 2010. PF was defined according to the criteria of the International Study Group of Pancreatic Fistula. Clinical and pre-and intraoperative data were compared between PF and non-PF patients. The recommended cutoff value of body mass index (BMI) as 20 kg/m2 was defined by receiver operating characteristic curve analysis. PF occurred in 53 (26.1%) of 203 patients. In univariate analysis, BMI and soft remnant pancreas were found to be risk factors of PF ( P = 0.027, P = 0.005). In multivariate analysis, BMI and soft pancreas were also risk factors of PF ( P = 0.040, P = 0.005). Patients with PF had a significantly longer hospital stay than non-PF patients ( P = 0.005). High BMI and soft pancreas were significant risk factors for PF.

Is it possible to predict outcome in cardiac ECMO? Analysis of preoperative risk factors

Perfusion ◽  
2007 ◽  
Vol 22 (4) ◽  
pp. 225-229 ◽  
Author(s):  
Kari Wagner ◽  
Ivar Risnes ◽  
Michael Abdelnoor ◽  
Harald M. Karlsen ◽  
Jan Ludvig Svennevig
Keyword(s):  
Risk Factors ◽  
Cardiac Failure ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Early Mortality ◽  
Cardiac Insufficiency ◽  
Preoperative Risk ◽  
Preoperative Risk Factors ◽  
Va Ecmo ◽  
Ecmo Treatment

Background. Serious heart failure may be treated with extracorporeal membrane oxygenation (ECMO) when other treatment fails. The aim of the present study was to analyse preoperative risk factors of early mortality in patients treated with veno-arterial (VA)-ECMO. Methods. We studied a total of 18 possible risk factors in 80 patients with severe cardiac insufficiency treated with VA-ECMO. All consecutive cases treated at our institution between Sept.1990 and May 2006 were included. Univariate analysis and multiple logistic regression analysis were performed on 16 risk factors. The endpoint was early mortality (any death within 30 days of ECMO treatment). Results. Thirty patients (37.5%) died within 30 days. Age, gender, cause of cardiac failure, pre-ECMO treatment (ventilator, NO, IABP) did not significantly influence early mortality. A higher SvO2 was associated with survival and remained significant in the multivariate analysis. Conclusion. Treatment with VA-ECMO in patients with severe cardiac failure may save lives. It is, however, difficult to predict outcome. In this study, only SvO2 values prior to ECMO were positively associated with survival. Perfusion (2007) 22, 225—229.

Abstract 12850: Complex Lesion Characteristics Would be the Potential Risk Factors for Ventricular Fibrillation With Acute Coronary Syndrome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Youichirou Sugizaki ◽  
Makoto Takemoto ◽  
Hiromi Toki ◽  
Yu Taniguchi ◽  
Nobuaki Igarashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Ventricular Fibrillation ◽  
Potential Risk ◽  
Multiple Logistic Regression Analysis ◽  
Influential Factors ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Potential Risk Factors

Background: In the setting of acute coronary syndrome (ACS), ventricular fibrillation (VF) was serious and fatal complication. However, even though ischemia was well known as the risk for occurrence of VF, what influential factors of ACS patients related to VF were still unclear. We performed extracorporeal cardiopulmonary resuscitation for VF with ACS patients taken to our institute and performed coronary angiography to make definite diagnosis. Accordingly, We sought to the risk factors for VF with ACS. Methods: Consecutive 246 ACS patients hospitalized and underwent emergent coronary revascularization from September 2010 to September 2014 were enrolled. In these, patients with VF were categorized into VF group, and patients without VF were into non-VF group. We reviewed patients’ characteristics, including medications, past histories and laboratory findings, and CAG findings (lesion characteristics with ACC/AHA classification, number of disease vessels, existence of chronic total occlusion (CTO) and left-main coronary artery (LMCA) lesion) retrospectively. Results: Fifty-seven patients developed ACS with VF (VF group), and 189 patients were without VF (non-VF group). Comparing between the groups, the morbidity of previous angina pectoris or coronary artery bypass grafting were significantly higher in VF groups (32.1%-16.0%, p=0.01, 14.3%-1.1%, p<0.001, respectively). The prevalence of Complex lesion characteristics, such as multi vessel disease, CTO and LMCA lesion, was also higher in VF group (71.9%-42.8%, 43.9%-13.9%, 15.8%-6.3%, all p < 0.025, retrospectively). Moreover, multiple logistic regression analysis revealed multi vessel disease and existence of CTO lesion were independent factors for VF. Conclusion: VF group had more complex characteristics of coronary artery disease. Complex lesion characteristics, such as multi vessel disease, CTO and LMCA lesion, would be potential risk factors of VF with ACS patients.

Risk Factors for Pancreatic Fistula after Stapled Gland Transection

2011 ◽  
Vol 77 (8) ◽  
pp. 965-970 ◽  
Author(s):  
Preeti D. Subhedar ◽  
Sameer H. Patel ◽  
Peter J. Kneuertz ◽  
Shishir K. Maithel ◽  
Charles A. Staley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Staple Line ◽  
Univariate Analysis ◽  
Fistula Formation ◽  
Staple Line Reinforcement ◽  
Mesh Reinforcement ◽  
Included Patient ◽  
Pancreatic Transection ◽  
Clinically Significant

The objective of this study was to identify risk factors for pancreatic fistula (PF) after stapled transection in distal pancreatectomy (DP). Patients undergoing DP using a stapler for transection between 2005 and 2009 were identified from a pancreatic resection database. Variables examined included patient and tumor characteristics, staple size, and the use of mesh reinforcement. Univariate and multivariate regression analyses were performed to identify risk factors for postoperative PF. One hundred forty-nine had stapled transection, and of these, 25 (17%) had mesh reinforcement. The overall morbidity and mortality rates were 28 per cent and less than 1 per cent; 34 (23%) were diabetic. The rate of clinically significant PF was 14 per cent. On univariate analysis, diabetes ( P = 0.04), a firm pancreas ( P = 0.03), use of mesh staple line reinforcement ( P = 0.02), use of a 4.1-mm staple cartridge ( P = 0.01), and blood loss greater than 100 mL ( P = 0.01) were associated with higher pancreatic fistula rates. On multivariate analysis, only the presence of diabetes (OR, 4.17; 95% CI, 1.1-15.3; P = 0.03) and the use of a 4.1-mm cartridge (OR, 8.57; 95% CI, 1.2-60.2; P = 0.03) were independently associated with pancreatic fistula formation. Stapled pancreatic transection provides an acceptable PF rate after DP. Diabetes and staple size influence PF rates. In our experience, use of mesh staple line reinforcement did not reduce the incidence of PF after stapled transection.

Case control study of gastrointestinal complications after cardiopulmonary bypass heart surgery

Perfusion ◽  
2009 ◽  
Vol 24 (3) ◽  
pp. 173-178 ◽  
Author(s):  
Guowei Zhang ◽  
Naishi Wu ◽  
Hongyu Liu ◽  
Hang Lv ◽  
Zhifa Yao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Perfusion Pressure ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Multiple Logistic Regression ◽  
Gastrointestinal Complications ◽  
Preoperative Serum

Background: Gastrointestinal complications (GIC) after cardiopulmonary bypass (CPB) surgery are rare, but, nevertheless, extremely dangerous.The identification of risks for GIC may be helpful in planning appropriate perioperative management strategies. The aim of the present study was to analyze perioperative factors of GIC in patients undergoing CPB surgery. Methods: We retrospectively analysed 206 patients who underwent GIC after cardiopulmonary bypass surgery from 2000 to 2007 and compared them with 206 matched control patients (matched for surgery, temperature, hemodilution and date). Univariate analysis and multiple logistic regression analysis were performed on 12 risk factors. Result: Sex and types of cardioplegia perfusate did not significantly influence the GIC after CPB surgery. Multiple logistic regression revealed that CPB time, preoperative serum creatinine (PSC) ≥ 179 mg/dL, emergency surgery, perfusion pressure ≤40mmHg, low cardiac output syndrome (LCOS), age ≥ 61, mechanical ventilation ≥96 h, New York Heart Association (NYHA) class III and IV were predictors of the occurrence of GIC after CPB surgery. Perfusion pressure and aprotinin administration were protective factors. Conclusion: Gastrointestinal complications after CPB surgery could be predictive in the presence of the above risk factors. This study suggests that GIC can be reduced by maintenance of higher perfusion pressure and shortening the time on CPB and ventilation.

scholarly journals Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Hiromichi Kawaida ◽  
Hiroshi Kono ◽  
Hidetake Amemiya ◽  
Naohiro Hosomura ◽  
Mitsuaki Watanabe ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Conventional Group ◽  
Short Term ◽  
Drainage Fluid ◽  
The Third ◽  
Modified Method ◽  
Early Removal ◽  
Soft Pancreas

Abstract Background Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD. Methods In total, 123 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n = 67) and a modified group (n = 56). Results The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p value = 0.002). Conclusions Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

scholarly journals C-reactive protein predicts complications in community-associated S. aureus bacteraemia: a cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carly L. Botheras ◽  
Steven J. Bowe ◽  
Raquel Cowan ◽  
Eugene Athan
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Potential Risk ◽  
Univariate Analysis ◽  
Foot Ulcer ◽  
Entry Point ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Potential Risk Factors ◽  
Portal Of Entry

Abstract Background Staphylococcus aureus (S. aureus) bacteraemia is increasingly acquired from community settings and is associated with a mortality rate of up to 40% following complications. Identifying risk factors for complicated S. aureus bacteraemia would aid clinicians in targeting patients that benefit from expedited investigations and escalated care. Methods In this prospective observational cohort study, we aimed to identify risk factors associated with a complicated infection in community-onset S. aureus bacteraemia. Potential risk factors were collected from electronic medical records and included: - patient demographics, symptomology, portal of entry, and laboratory results. Results We identified several potential risk factors using univariate analysis. In a multiple logistic regression model, age, haemodialysis, and entry point from a diabetic foot ulcer were all significantly protective against complications. Conversely, an unknown entry point of infection, an entry point from an indwelling medical device, and a C-reactive protein concentration of over 161 mg/L on the day of admission were all significantly associated with complications. Conclusions We conclude that several factors are associated with complications including already conducted laboratory investigations and portal of entry of infection. These factors could aid the triage of at-risk patients for complications of S. aureus bacteraemia.

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