The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy: An analysis of the American college of surgeons national surgical quality improvement program database

Anthony W. Castleberry, Rebekah R. White, Sebastian G. De La Fuente, Bryan M. Clary, Dan G. Blazer, Richard L. McCann, Theodore N. Pappas, Douglas Tyler, John E. Scarborough

Research output: Contribution to journalArticle

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Abstract

Background. Several single-center reports suggest that vascular resection (VR) during pancreaticoduodenectomy (PD) for patients with pancreatic adenocarcinoma is feasible without affecting early postoperative mortality or morbidity. Our objective is to review the outcomes associated with VR during PD using a large multicenter data source. Methods. A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009. All patients undergoing PD for a postoperative diagnosis of malignant neoplasm of the pancreas were included. Forward stepwise multivariate regression analysis was used to determine the association between VR during PD and 30-day postoperative mortality and morbidity after adjustment for patient demographics and comorbidities. Results. 3,582 patients were included for analysis, 281 (7.8 %) of whom underwent VR during PD. VR during PD was associated with significantly greater risk-adjusted 30-day postoperative mortality >5.7 % with VR versus 2.9 % without VR, adjusted odds ratio (AOR) 2.1, 95 % confidence interval (CI) 1.22-3.73, P = 0.008] and overall morbidity (39.9 % with VR versus 33.3 % without VR, AOR 1.36, 95 % CI 1.05-1.75, P = 0.02). There was no significant difference in risk-adjusted postoperative mortality or morbidity between those patients undergoing VR by the primary surgical team versus those patients undergoing VR by a vascular surgical team. Conclusions. Contrary to the findings of several previously published single-center analyses, the current study demonstrates increased 30-day postoperative morbidity and mortality in PD with VR when compared with PD alone.

Original languageEnglish (US)
Pages (from-to)4068-4077
Number of pages10
JournalAnnals of Surgical Oncology
Volume19
Issue number13
DOIs
StatePublished - Dec 2012
Externally publishedYes

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Pancreaticoduodenectomy
Quality Improvement
Blood Vessels
Databases
Morbidity
Mortality
Surgeons
Odds Ratio
Confidence Intervals
Information Storage and Retrieval
Pancreatic Neoplasms
Comorbidity
Adenocarcinoma
Cohort Studies
Multivariate Analysis

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy : An analysis of the American college of surgeons national surgical quality improvement program database. / Castleberry, Anthony W.; White, Rebekah R.; De La Fuente, Sebastian G.; Clary, Bryan M.; Blazer, Dan G.; McCann, Richard L.; Pappas, Theodore N.; Tyler, Douglas; Scarborough, John E.

In: Annals of Surgical Oncology, Vol. 19, No. 13, 12.2012, p. 4068-4077.

Research output: Contribution to journalArticle

Castleberry, Anthony W. ; White, Rebekah R. ; De La Fuente, Sebastian G. ; Clary, Bryan M. ; Blazer, Dan G. ; McCann, Richard L. ; Pappas, Theodore N. ; Tyler, Douglas ; Scarborough, John E. / The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy : An analysis of the American college of surgeons national surgical quality improvement program database. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 13. pp. 4068-4077.
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abstract = "Background. Several single-center reports suggest that vascular resection (VR) during pancreaticoduodenectomy (PD) for patients with pancreatic adenocarcinoma is feasible without affecting early postoperative mortality or morbidity. Our objective is to review the outcomes associated with VR during PD using a large multicenter data source. Methods. A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009. All patients undergoing PD for a postoperative diagnosis of malignant neoplasm of the pancreas were included. Forward stepwise multivariate regression analysis was used to determine the association between VR during PD and 30-day postoperative mortality and morbidity after adjustment for patient demographics and comorbidities. Results. 3,582 patients were included for analysis, 281 (7.8 {\%}) of whom underwent VR during PD. VR during PD was associated with significantly greater risk-adjusted 30-day postoperative mortality >5.7 {\%} with VR versus 2.9 {\%} without VR, adjusted odds ratio (AOR) 2.1, 95 {\%} confidence interval (CI) 1.22-3.73, P = 0.008] and overall morbidity (39.9 {\%} with VR versus 33.3 {\%} without VR, AOR 1.36, 95 {\%} CI 1.05-1.75, P = 0.02). There was no significant difference in risk-adjusted postoperative mortality or morbidity between those patients undergoing VR by the primary surgical team versus those patients undergoing VR by a vascular surgical team. Conclusions. Contrary to the findings of several previously published single-center analyses, the current study demonstrates increased 30-day postoperative morbidity and mortality in PD with VR when compared with PD alone.",
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T1 - The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy

T2 - An analysis of the American college of surgeons national surgical quality improvement program database

AU - Castleberry, Anthony W.

AU - White, Rebekah R.

AU - De La Fuente, Sebastian G.

AU - Clary, Bryan M.

AU - Blazer, Dan G.

AU - McCann, Richard L.

AU - Pappas, Theodore N.

AU - Tyler, Douglas

AU - Scarborough, John E.

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N2 - Background. Several single-center reports suggest that vascular resection (VR) during pancreaticoduodenectomy (PD) for patients with pancreatic adenocarcinoma is feasible without affecting early postoperative mortality or morbidity. Our objective is to review the outcomes associated with VR during PD using a large multicenter data source. Methods. A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009. All patients undergoing PD for a postoperative diagnosis of malignant neoplasm of the pancreas were included. Forward stepwise multivariate regression analysis was used to determine the association between VR during PD and 30-day postoperative mortality and morbidity after adjustment for patient demographics and comorbidities. Results. 3,582 patients were included for analysis, 281 (7.8 %) of whom underwent VR during PD. VR during PD was associated with significantly greater risk-adjusted 30-day postoperative mortality >5.7 % with VR versus 2.9 % without VR, adjusted odds ratio (AOR) 2.1, 95 % confidence interval (CI) 1.22-3.73, P = 0.008] and overall morbidity (39.9 % with VR versus 33.3 % without VR, AOR 1.36, 95 % CI 1.05-1.75, P = 0.02). There was no significant difference in risk-adjusted postoperative mortality or morbidity between those patients undergoing VR by the primary surgical team versus those patients undergoing VR by a vascular surgical team. Conclusions. Contrary to the findings of several previously published single-center analyses, the current study demonstrates increased 30-day postoperative morbidity and mortality in PD with VR when compared with PD alone.

AB - Background. Several single-center reports suggest that vascular resection (VR) during pancreaticoduodenectomy (PD) for patients with pancreatic adenocarcinoma is feasible without affecting early postoperative mortality or morbidity. Our objective is to review the outcomes associated with VR during PD using a large multicenter data source. Methods. A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009. All patients undergoing PD for a postoperative diagnosis of malignant neoplasm of the pancreas were included. Forward stepwise multivariate regression analysis was used to determine the association between VR during PD and 30-day postoperative mortality and morbidity after adjustment for patient demographics and comorbidities. Results. 3,582 patients were included for analysis, 281 (7.8 %) of whom underwent VR during PD. VR during PD was associated with significantly greater risk-adjusted 30-day postoperative mortality >5.7 % with VR versus 2.9 % without VR, adjusted odds ratio (AOR) 2.1, 95 % confidence interval (CI) 1.22-3.73, P = 0.008] and overall morbidity (39.9 % with VR versus 33.3 % without VR, AOR 1.36, 95 % CI 1.05-1.75, P = 0.02). There was no significant difference in risk-adjusted postoperative mortality or morbidity between those patients undergoing VR by the primary surgical team versus those patients undergoing VR by a vascular surgical team. Conclusions. Contrary to the findings of several previously published single-center analyses, the current study demonstrates increased 30-day postoperative morbidity and mortality in PD with VR when compared with PD alone.

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