Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
HPB (Oxford). 2024 Feb;26(2):251-258. doi: 10.1016/j.hpb.2023.10.010. Epub 2023 Oct 12.
Patient- and hospital-level factors associated with outcomes following pancreatoduodenectomy (PD) are well established. However, despite theoretical disruption in hepatopetal flow, the impact of cirrhosis on in-hospital mortality following PD is not well-studied. The objective of this study was to evaluate in-hospital mortality, length of stay (LOS), and post-discharge disposition in patients with cirrhosis undergoing PD.
A retrospective analysis of the National Inpatient Sample (January 2002-August 2015) was conducted identifying patients undergoing PD. Using previously validated ICD-9-CM codes, patients were stratified into presence and absence of cirrhosis. Factors associated with in-hospital mortality following PD were analyzed adjusting for patient- and hospital-level factors. Following PD were analyzed after adjusting for patient- and hospital-level factors.
In 16,344 patients that underwent PD, 203 (1.2 %) patients had underlying cirrhosis prior to resection. Overall in-hospital mortality following PD was significantly worse in the cirrhosis cohort (11.3 % vs. 3.6 %, p < 0.001). Patients with underlying cirrhosis were less likely to be discharged home (73.9 % vs. 83.2 %, p < 0.001) and had a longer median LOS (12.0 vs. 10.0 days, p = 0.001).
The presence of underlying cirrhosis is associated with increased in-hospital mortality, longer LOS, and decreased likelihood of home discharge following PD. Given the prohibitive risks, PD should not be performed in patients with underlying cirrhosis.
胰十二指肠切除术（PD）后与患者和医院相关的结果因素已经得到很好的证实。然而，尽管存在顺行性肝内血流理论上的中断，但肝硬化对 PD 后院内死亡率的影响尚未得到很好的研究。本研究的目的是评估肝硬化患者行 PD 后的院内死亡率、住院时间（LOS）和出院后去向。
对 2002 年 1 月至 2015 年 8 月国家住院患者样本（National Inpatient Sample）进行回顾性分析，确定行 PD 的患者。使用先前验证的 ICD-9-CM 代码，将患者分为存在和不存在肝硬化。分析 PD 后与院内死亡率相关的因素，并对患者和医院水平的因素进行调整。
在 16344 例行 PD 的患者中，有 203 例（1.2%）患者在切除前有基础肝硬化。PD 后肝硬化组的院内死亡率明显更高（11.3% vs. 3.6%，p<0.001）。有基础肝硬化的患者出院回家的可能性较小（73.9% vs. 83.2%，p<0.001），中位 LOS 较长（12.0 天 vs. 10.0 天，p=0.001）。
基础肝硬化的存在与 PD 后院内死亡率增加、LOS 延长和出院回家的可能性降低相关。鉴于潜在风险，不应对基础肝硬化患者行 PD。
