Predictors of Clavien 4 Complications and Mortality After Necrosectomy: Analysis of the NSQIP Database

Authors

Nina Kolbe, Henry Ford HealthFollow
Stephanie Bakey, Henry Ford Health
Lisa Louwers, Henry Ford Health
Dionne J. Blyden, Henry Ford HealthFollow
Mathilda Horst, Henry Ford Health
Anthony Falvo, Henry Ford HealthFollow
Joe Patton, Henry Ford Health
Ilan Rubinfeld, Henry Ford HealthFollow

Recommended Citation

Kolbe N, Bakey S, Louwers L, Blyden D, Horst M, Falvo A, Patton J, Rubinfeld I. Predictors of Clavien 4 Complications and Mortality After Necrosectomy: Analysis of the NSQIP Database. J Gastrointest Surg. 2015 Jun;19(6):1086-92.

Document Type

Article

Publication Date

6-1-2015

Publication Title

Journal of gastrointestinal surgery

Abstract

BACKGROUND: Acute severe pancreatitis is one of the most common gastrointestinal reasons for admission to hospitals in the USA. Up to 20 % of these patients will progress to necrotizing pancreatitis requiring intervention. The aim of this study is to identify specific preoperative factors for the development of Clavien 4 complications and mortality in patients undergoing pancreatic necrosectomy.

METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use files were reviewed from 2007 to 2012 to identify patients who underwent a pancreatic necrosectomy. Postoperative complications were stratified into Clavien 4 (ICU level complications) and Clavien 5 (mortality). Univariate and multivariate analyses were performed.

RESULTS: A total of 1156 patients underwent a pancreatic necrosectomy from 2007 to 2012. Overall, 42 % of patients experienced a Clavien 4 complication. Mortality rate was 9.5 %. Nonindependent functional status and ASA class were highly significant (p < 0.001) in univariate analysis. Frailty and emergency surgery status (p < 0.001), as well as increased blood urea nitrogen (BUN) and alkaline phosphatase and decreased albumin (p < 0.05) demonstrated independent significance of Clavien 4 complications and mortality in multivariate analysis.

CONCLUSION: This study identified specific preoperative variables that place patients at increased risk of Clavien 4 complications and mortality after necrosectomy. Identification of high-risk patients can aid in selection of appropriate treatment strategies and allow for informed preoperative discussion regarding surgical risk.

Medical Subject Headings

Adult; Debridement; Female; Humans; Male; Middle Aged; Pancreatectomy; Pancreatitis, Acute Necrotizing; Postoperative Complications; Survival Rate; United States

PubMed ID

25862000

Volume

19

Issue

6

First Page

1086

Last Page

1092