Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
HPB (Oxford). 2014 Mar;16(3):250-62. doi: 10.1111/hpb.12107. Epub 2013 Apr 18.
The timing of major elective operations is a potentially important but rarely examined outcome variable. This study examined elective pancreaticoduodenectomy (PD) timing as a perioperative outcome variable.
Consecutive patients submitted to PD were identified. Determinants of 90-day morbidity (prospectively graded and tracked), anastomotic leak or fistula, and mortality, including operation start time (time of day), day of week and month, were assessed in univariate and multivariate analyses. Operation start time was analysed as a continuous and a categorical variable.
Of the 819 patients identified, 405 (49.5%) experienced one or more complications (total number of events = 684); 90-day mortality was 3.5%. On multivariate analysis, predictors of any morbidity included male gender (P = 0.009) and estimated blood loss (P = 0.017). Male gender (P = 0.002), benign diagnosis (P = 0.002), presence of comorbidities (P = 0.002), American Society of Anesthesiologists (ASA) score (P = 0.025), larger tumour size (P = 0.013) and positive resection margin status (P = 0.005) were associated with the occurrence of anastomotic leak or fistula. Cardiac and pulmonary comorbidities were the only variables associated with 90-day mortality. Variables pertaining to procedure scheduling were not associated with perioperative morbidity or mortality. Operation start time was not significant when analysed as a continuous or a categorical variable, or when stratified by surgeon.
Perioperative outcome after PD is determined by patient, disease and operative factors and does not appear to be influenced by procedure timing.
择期大型手术的时间是一个潜在的重要但很少被研究的结果变量。本研究检查了作为围手术期结果变量的择期胰十二指肠切除术 (PD) 的时间。
连续入选接受 PD 的患者。在单因素和多因素分析中，评估了 90 天发病率（前瞻性分级和跟踪）、吻合口漏或瘘以及死亡率的决定因素，包括手术开始时间（一天中的时间）、星期几和月份。手术开始时间以连续和分类变量进行分析。
在确定的 819 名患者中，有 405 名（49.5%）经历了一种或多种并发症（总事件数为 684 例）；90 天死亡率为 3.5%。多因素分析显示，任何发病率的预测因素包括男性（P = 0.009）和估计出血量（P = 0.017）。男性（P = 0.002）、良性诊断（P = 0.002）、并存疾病（P = 0.002）、美国麻醉医师协会（ASA）评分（P = 0.025）、肿瘤较大（P = 0.013）和阳性切缘状态（P = 0.005）与吻合口漏或瘘的发生有关。心脏和肺部并存疾病是唯一与 90 天死亡率相关的变量。与手术时间相关的变量与围手术期发病率或死亡率无关。手术开始时间作为连续或分类变量分析时、或按外科医生分层时均不显著。
PD 后的围手术期结果由患者、疾病和手术因素决定，似乎不受手术时间的影响。
