Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, Italy.
Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, Italy.
Surgery. 2022 Jul;172(1):329-335. doi: 10.1016/j.surg.2022.01.005. Epub 2022 Feb 23.
Mortality is consistently reported as an outcome metric in pancreatic surgery. Given its heterogeneity, better characterization of it might provide crucial insights for clinical practice. This study aimed to analyze the timeline and sequence of events that lead to death after pancreatoduodenectomy to identify possible distinct pathways of mortality.
All consecutive pancreatoduodenectomy cases from 2010 to 2020 were retrospectively analyzed. A day-to-day appraisal of the postoperative course of each fatality was performed and visualized graphically. The graphical analysis allowed for pattern identification. The respective predictors were explored through logistic regression.
Out of 2065 pancreatoduodenectomy patients, in-hospital mortality was 3.1%. With graphical analysis, 3 patterns were identified. Pattern A deaths (71.4%, n = 45) occurred after a median of 43 days (14-260), following pancreas-specific complications such as postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. Pattern B deaths (15.9%, n = 10) occurred after a median of 18 days (1-55), succeeding a critical status in the early postoperative course, mainly related to elevated surgical complexity. Patients with pattern C (12.7%) died after a median of 8 days, mostly for unknown cause after an uneventful postoperative course. The predictors of each pattern were distinctive.
Mortality after pancreatoduodenectomy occurs through 3 distinct pathways. This knowledge could spawn an additional endpoint of value to clinicians and hospitals, delivering a supplementary tool for comparison between centers and diversified patient populations, and it might facilitate the identification of the best targets for improvement. Further studies are needed to validate this tripartite reclassification.
死亡率一直被报道为胰腺外科的一种结局指标。鉴于其异质性，对其进行更好的描述可能为临床实践提供关键的见解。本研究旨在分析导致胰十二指肠切除术后死亡的时间线和事件序列，以确定可能存在的不同死亡途径。
回顾性分析了 2010 年至 2020 年期间所有连续的胰十二指肠切除术病例。对每个死亡病例的术后过程进行逐日评估，并以图形方式可视化。图形分析允许识别模式。通过逻辑回归探讨了各自的预测因素。
在 2065 例胰十二指肠切除术患者中，院内死亡率为 3.1%。通过图形分析，确定了 3 种模式。模式 A 死亡（71.4%，n=45）发生在术后中位时间 43 天（14-260 天），随后出现胰腺特异性并发症，如术后胰瘘、胰切除术后出血和延迟胃排空。模式 B 死亡（15.9%，n=10）发生在术后中位时间 18 天（1-55 天），主要与早期术后发生危急状态有关，主要与手术复杂性增加有关。模式 C（12.7%）的患者在术后中位时间 8 天死亡，大多数在术后无并发症的情况下死因不明。每种模式的预测因素均有其独特性。
胰十二指肠切除术后的死亡率通过 3 种不同途径发生。这种知识可能会产生一个额外的有价值的终点，为临床医生和医院提供一个补充的工具，用于比较中心和不同患者人群，并可能有助于确定最佳的改进目标。需要进一步的研究来验证这种三分重新分类。
