Department of Surgery, Krankenhaus der Elisabethinen, Academic Teaching Hospital of the Medical Universities of Graz, Innsbruck and Vienna, Fadingerstrasse 1, 4020 Linz, Austria.
World J Surg. 2011 Oct;35(10):2306-14. doi: 10.1007/s00268-011-1213-5.
The purpose of the study was to determine the incidence of any unplanned reoperation or reintervention procedure after pancreatic resection and to identify the underlying risk factors.
A total of 189 consecutive pancreatic resections performed from 2001-2008 were searched for any unplanned reoperation, percutaneous drainage, or angiographic reintervention. A retrospective analysis of a prospectively maintained database, including patient characteristics, comorbidities, details of surgery, specific complications, incidence of reoperation/reintervention, and mortality was performed.
Overall rates of reoperation, reintervention, and mortality were 6.3% (12/189), 7.9% (15/189), and 1.6% (3/189), respectively. Four patients underwent reintervention and reoperation, so the combined reoperation/reintervention rate was 12.2% (23/189). Reoperation (P < 0.001) and reintervention (P = 0.002) correlated with mortality. Hemorrhage (relative risk [RR], 58; P = 0.0017) and the combination of hemorrhage and pancreatic fistula (RR, 117; P < 0.0001) were identified as risk factors for unplanned reoperation, hemorrhage (RR, 82; P = 0.005), pancreatic fistula (RR, 42; P < 0.001), and the combination of both complications (RR, 246; P < 0.001) for reoperation and/or reintervention. Other patient- or procedure-related factors did not influence the reoperation and/or reintervention rates significantly.
Pancreatic fistula and hemorrhage are the predominant factors that afford unplanned reoperation/reintervention. Although reporting the incidence of unplanned reoperation will include the most severe postoperative complications, a considerable number of reinterventions are missed. Therefore, in outcome analyses of pancreatic surgery, not only reoperations but also any interventional therapies should be included.
本研究旨在确定胰腺切除术后计划性再手术或再介入治疗的发生率，并确定潜在的危险因素。
对 2001 年至 2008 年期间进行的 189 例连续胰腺切除术进行搜索，以确定任何计划性再手术、经皮引流或血管造影再介入治疗。对前瞻性维护的数据库进行回顾性分析，包括患者特征、合并症、手术细节、具体并发症、再手术/再介入治疗的发生率和死亡率。
总体再手术、再介入和死亡率分别为 6.3%（12/189）、7.9%（15/189）和 1.6%（3/189）。4 例患者行再介入和再手术，因此联合再手术/再介入率为 12.2%（23/189）。再手术（P<0.001）和再介入（P=0.002）与死亡率相关。出血（相对风险[RR]，58；P=0.0017）和出血与胰瘘的组合（RR，117；P<0.0001）被确定为计划性再手术的危险因素，出血（RR，82；P=0.005）、胰瘘（RR，42；P<0.001）和两者并发症的组合（RR，246；P<0.001）为再手术和/或再介入治疗的危险因素。其他患者或手术相关因素对再手术和/或再介入治疗的发生率没有显著影响。
胰瘘和出血是计划性再手术/再介入治疗的主要因素。尽管报告计划性再手术的发生率将包括术后最严重的并发症，但相当数量的再介入治疗被遗漏。因此，在胰腺手术的结果分析中，不仅应包括再手术，还应包括任何介入治疗。
