Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
Langenbecks Arch Surg. 2011 Mar;396(3):353-62. doi: 10.1007/s00423-010-0629-y. Epub 2010 Mar 25.
Pancreaticoduodenectomy (PD) is standard for patients with resectable pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head, neck, and uncinate process, but it is associated with a relatively high morbidity. This study aimed to identify risk factors for extended postoperative intensive care unit (ICU) admission and assess the impact of ICU treatment on patient survival.
Between October 2001 and June 2008, patients that underwent PD for PDAC in the pancreatic head were identified from a prospective database. Patients admitted to the ICU after an initial recovery period were compared to those not admitted regarding comorbidities, intraoperative parameters, resection size, and tumor biology.
Five hundred and forty patients were included. Of these, 17.8% required extended postoperative ICU admission (immediate, 9.3%; delayed, 7.6%). Immediate ICU admission was most frequently required for increased intraoperative blood loss and fluid management. Delayed ICU treatment was most frequently required for hemorrhage, respiratory insufficiency, or pancreatic fistula. Morbidity and 30-day mortality rates were 54.2% and 2.6%, respectively. ICU admission correlated with significantly lower survival rates compared to no ICU admission (P = 0.0155). Multivariate risk factors for ICU admission included a history of diabetes mellitus and heart failure (NYHA I-III), an intraoperative blood transfusion, and a longer operating time.
The need for extended ICU admission is associated with higher in-hospital mortality and reduced long-term outcome. The highest mortality was observed after delayed ICU admission. Preoperative diabetes, heart failure and long operations, and intraoperative blood transfusions substantially increased the risk for ICU requirement.
胰十二指肠切除术（PD）是治疗胰头、颈部和钩突部可切除胰腺导管腺癌（PDAC）的标准方法，但它与相对较高的发病率相关。本研究旨在确定延长术后重症监护病房（ICU）入住的风险因素，并评估 ICU 治疗对患者生存的影响。
2001 年 10 月至 2008 年 6 月期间，从一个前瞻性数据库中确定了因 PDAC 在胰头部接受 PD 的患者。将初始恢复期后入住 ICU 的患者与未入住 ICU 的患者进行比较，比较内容包括合并症、术中参数、切除大小和肿瘤生物学。
共纳入 540 例患者。其中，17.8%需要延长术后 ICU 入住（即刻入住，9.3%；延迟入住，7.6%）。即刻入住 ICU 最常因术中出血量增加和液体管理而需要。延迟入住 ICU 最常因出血、呼吸功能不全或胰瘘而需要。发病率和 30 天死亡率分别为 54.2%和 2.6%。与未入住 ICU 相比，入住 ICU 与生存率显著降低相关（P=0.0155）。入住 ICU 的多变量危险因素包括糖尿病和心力衰竭（NYHA I-III）病史、术中输血和手术时间延长。
需要延长 ICU 入住与更高的院内死亡率和降低的长期预后相关。延迟入住 ICU 后的死亡率最高。术前糖尿病、心力衰竭和手术时间长以及术中输血大大增加了入住 ICU 的风险。
