Perioperative outcomes for the emergent Whipple operation in the United States: An analysis of the American College of Surgeons National Surgical Quality Improvement Program

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Conference Proceeding

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J Am Coll Surg


INTRODUCTION: Emergent pancreaticoduodenectomy (EMPD) has been safely performed for acute pancreaticoduodenal surgical situations. It is unclear whether the morbidity associated with EMPD is due to technical complexities of the surgery or the surgical situation. METHODS: We sought to compare outcomes of all patients undergoing elective (ELPD) and EMPD between 2005 and 2014 utilizing the American College of Surgeons NSQIP database. Univariate and multivariable analyses were performed to identify the impact on perioperative outcomes. RESULTS: There were 24, 328 ELPD and 194 EMPD identified. Patients with EMPD had worse functional status and American So-ciety of Anesthesiologists, and more often, acute renal failure and dialysis requirements (3.6% vs 0.1%, p < 0.001 and 5.2% vs 0.4%, p < 0.001). Additionally, EMPD had higher rates of ventilator > 48 hours (4.9% vs 15.5%,), Clavien 4 and higher complications (10.3% vs 28.9%), and death (3.2% vs 10.8%), p < 0.001. There were no differences in superficial incisional surgical site infections (SSI) (9.6% vs 8.8% p = 0.785) or organ/space SSI (11.9% vs 16.0%, p = 0.106). On multivariable analysis, EMPD was an independent risk factor for death (odds ratio [OR] 2.21, p = 0.00173), Clavien 4 complication (OR 2.38, p < 0.001), but not for organ space SSI (OR 1.38, p = 0.1094), renal failure (OR 1.129, p = 0.791), or MI (OR 1.506, p = 0.492). CONCLUSIONS: EMPD has a worse complication profile than ELPD. The lack of significance in organ space SSI suggests that the high morbidity of EMPD is more likely associated with the inciting surgical event rather than the technical complexity of the surgery.




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