Risk of Morbidity and Mortality Following Hepato-Pancreato-Biliary Surgery

Peter J. Kneuertz, Henry A. Pitt, Karl Y. Bilimoria, Jill P. Smiley, Mark E. Cohen, Clifford Y. Ko, Timothy M. Pawlik

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122 Scopus citations

Abstract

Introduction: Hepatic, pancreatic, and complex biliary (HPB) surgery can be associated with major morbidity and significant mortality. For the past 5 years, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has gathered robust data on patients undergoing HPB surgery. We sought to use the ACS-NSQIP data to determine which preoperative variables were predictive of adverse outcomes in patients undergoing HPB surgery. Methods: Data collected from ACS-NSQIP on patients undergoing hepatic, pancreatic, or complex biliary surgery between 2005 and 2009 were analyzed (n = 13,558). Diagnoses and surgical procedures were categorized into 10 and eight groups, respectively. Seventeen preoperative clinical variables were assessed for prediction of 30-day postoperative morbidity and mortality. Multivariate logistic regression was utilized to develop a risk model. Results: Of the 13,558 patients who underwent an HPB procedure, 7,321 (54%) had pancreatic, 4,881 (36%) hepatic, and 1,356 (10%) biliary surgery. Overall, 70. 3% of patients had a cancer diagnosis. Post-operative complications occurred in 3,850 patients for an overall morbidity of 28. 4%. Serious complications occurred in 2,522 (18. 6%) patients; 366 patients died for an overall peri-operative mortality of 2. 7%. Peri-operative outcome was associated with diagnosis and type of procedure. Hepatic trisectionectomy (5. 8%) and total pancreatectomy (5. 4%) had the highest 30-day mortality. Of the preoperative variables examined, age >74, dyspnea with moderate exertion, steroid use, prior cardiac procedure, ascites, and pre-operative sepsis were associated with morbidity and mortality (all P < 0. 05). Conclusions: While overall morbidity and mortality for HPB surgery are low, peri-operative outcomes are heterogeneous and depend on diagnosis, procedure type, and key clinical factors. By combining these factors, an ACS-NSQIP "HPB Risk Calculator" may be developed in the future to help better risk-stratify patients being considered for complex HPB surgery.

Original languageEnglish (US)
Pages (from-to)1727-1735
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume16
Issue number9
DOIs
StatePublished - Sep 1 2012

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Keywords

  • HPB
  • Morbidity
  • Mortality
  • NSQIP
  • Outcomes
  • Risk prediction
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Kneuertz, P. J., Pitt, H. A., Bilimoria, K. Y., Smiley, J. P., Cohen, M. E., Ko, C. Y., & Pawlik, T. M. (2012). Risk of Morbidity and Mortality Following Hepato-Pancreato-Biliary Surgery. Journal of Gastrointestinal Surgery, 16(9), 1727-1735. https://doi.org/10.1007/s11605-012-1938-y