Predicting the Severity of Pancreatic Fistula after Pancreaticoduodenectomy: Overweight and Blood Loss as Independent Risk Factors: Retrospective Analysis of 277 Patients

2019 ◽  
Vol 20 (6) ◽  
pp. 486-491 ◽  
Author(s):  
Alban Zarzavadjian Le Bian ◽  
David Fuks ◽  
Filippo Montali ◽  
Manuela Cesaretti ◽  
Renato Costi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Pancreatic Fistula ◽  
Retrospective Analysis ◽  
Independent Risk Factors

scholarly journals Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuanxing Zhou ◽  
Xin Fu ◽  
Ming Yang ◽  
Song Ke ◽  
Bo Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Linear Regression ◽  
Blood Loss ◽  
Interbody Fusion ◽  
Fibrinogen Level ◽  
Muscle Thickness ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Hidden Blood Loss ◽  
Independent Risk Factors

Abstract Background With respect to spinal surgeries, elucidating absolute and relative amount of hidden blood loss (HBL) is of great importance in order to avoid aforementioned potential complications. To evaluate HBL and its possible risk factors among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases. Methods Between June 2018 and March 2019, 137 consecutive patients with lumbar degenerative disease, who underwent operation with MIS-TLIF technique, were enrolled in this study. The patient’s demographic characteristics and blood loss-related parameters were collected, respectively. The Pearson or Spearman correlation analysis was used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was used to confirm independent risk factors of HBL. Results A total of 137 patients (86 males and 51 females, age range 19–78 years) were reviewed in our hospital. A substantial amount of HBL (488.4 ± 294.0 ml, 52.5% of TBL) occurred after MIS-TLIF. Multivariate linear regression showed that the age, muscle thickness, the Patients’ Society of Anesthesiologists (ASA) classification, patient’s blood volume (PBV), total blood loss (TBL), postoperative (i.e., day 2 or 3) hematocrit (Hct), Hct loss, and fibrinogen level were independent risk factors for HBL (P1 = 0.000, P2 = 0.002, P3 = 0.006, P4 = 0.002, P5 = 0.003, P6 = 0.048, P7 = 0.004, P8 = 0.000). Conclusion A large amount of HBL was incurred in patients undergoing MIS-TLIF. More importantly, the age, muscle thickness, ASA classification, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen level were independent risk factors for HBL in MIS-TLIF. HBL and its risk factors should be paid more attention to during the perioperative period.

scholarly journals Analysis of Risk Factors for Perioperative Hidden Blood Loss in Unilateral Biportal Endoscopic Spine Surgery: A Retrospective Multicenter Study

2021 ◽  
Author(s):  
Haosheng Wang ◽  
Kai Wang ◽  
Bin Lv ◽  
Wenle Li ◽  
Tingting Fan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Linear Regression ◽  
Blood Loss ◽  
Spine Surgery ◽  
Linear Regression Analysis ◽  
Total Blood Loss ◽  
Total Blood ◽  
Hidden Blood Loss ◽  
Independent Risk Factors

Abstract Background Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and it’s possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases. Methods This multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients underwent UBE surgery were extracted by electronic medical record system. The patient’s demographic characteristics and blood loss-related parameters were recorded. We calculated the amount of HBL and explored the association between patient’s characteristics and HBL using Pearson or Spearman correlation analysis. Multivariate linear regression analysis was conducted to identity independent risk factors of HBL. Results A total of 136 patients (55 females and 81 males, age range 43 to 74 years) were included in this study. A substantial amount of HBL (469.5 ± 195.3 ml, 57.6 % of TBL, total blood loss) occurred following UBE surgery. Multiple linear regression analysis indicated that the risk factors of HBL were as follows: age (P = 0.000), number of fusion levels (P = 0.015), American Society of Anesthesiologists (ASA) classification (P = 0.046), surgery time (P = 0.017), patient’s blood volume (PBV, P = 0.026), total blood loss (TBL, P = 0.001), postoperative (i.e., day 2 or 3) hematocrit(Hct, P = 0.034), Hct loss (P = 0.005), and fibrinogen (P = 0.028). Conclusions A certain amount of HBL occurs in UBE surgery and cannot be ignored in daily clinical practice. The age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen are independent risk factors for HBL.

scholarly journals Hidden Blood Loss in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion Surgery: A Retrospective Study of 765 Cases in a Single Center

2021 ◽  
Author(s):  
Lipeng Wang ◽  
Jiangli Liu ◽  
Xiaoxiao Song ◽  
Muhui Luo ◽  
Yongquan Chen
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Postoperative Blood Transfusion ◽  
Independent Risk Factors

Abstract Purpose: To investigate Hidden blood loss (HBL) and its potential risk factors in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgery and elucidate the influence of HBL on postoperative blood transfusion. Methods: We retrospectively studied 765 patients undergoing posterior spine fusion for adolescent idiopathic scoliosis from January 2014 to December 2018. The patient’s demographics, blood loss related parameters, operation and blood loss information were extracted. The association between patient’s characteristics and HBL was analyzed by Pearson or Spearman correlation analysis. Multivariate linear regression analysis was used to determine independent risk factors associated with HBL. Binary logistic regression analysis was used to analyze the influence of HBL on postoperative blood transfusion.Results: A total of 765 patients including 128 males and 637 females (age range 10-18 years) were included in this study. The mean amount of HBL was 693.5±473.4 ml, accounting for 53.9% of the total blood loss. In multivariate linear regression analysis, we found that preoperative Hct (p=0.003) and allogeneic blood transfusion (p<0.0001) were independent risk factors for HBL, while tranexamic acid (p=0.003) was negatively related to HBL. Binary logistic regression analysis showed that HBL > 850 ml ( P < 0.001, OR: 8.845, 95%CI: 5.806-13.290) was the independent risk factor for postoperative blood transfusion.Conclusion: a large amount of HBL was incurred in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgeries. Allogeneic blood transfusion and preoperative Hct were independent risk factors for HBL, while tranexamic acid was negatively related to HBL. HBL and its influential factors should be taken into account when considering the perioperative transfusion management. These patients with HBL greater than 850 ml should be paid more attention in case of postoperative anemia.Level of evidence: Level III

scholarly journals Retrospective analysis of risk factors for occurrence of pancreatic fistula in patients following pancreaticoduodenectomy

2018 ◽  
Vol 22 (3) ◽  
pp. 436-441
Author(s):  
K.G. Valikhnovska
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Retrospective Analysis ◽  
Pancreatic Head ◽  
Fistula Formation ◽  
Surgical Interventions ◽  
Periampullary Tumors ◽  
Pancreatic Fistulas

Pancreaticoduodenectomy still is a “gold standard” in treatment of hepatopancreaticobiliary tumors. The causes of pancreatic fistula were analyzed in 414 patients aged from 22 to 81 following pancreaticoduodenectomy due to periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve outcomes of pancreatic resection based on a retrospective analysis of the causes of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. Influence of risk factors of pancreatic fistula formation was evaluated by Pirson’s method (χ2). The factors contributing to the occurrence of pancreatic fistulas included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head; χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=17.83,1, p=0.0001, p<0.001) and technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage; χ2=16.40,1, p=0.0001, p<0.001). The detailed study of risk factors for the occurrence of pancreatic fistula is essential for improving the prognosis, prophylaxis and treatment of this pathology. The quality of the surgical intervention and the course of the postoperative period in patients with periampullary tumors depend on the choice of resection type, techniques for surgical interventions on the pancreas.

scholarly journals Risk Factors for Severe 30-d Complications After Minimally Invasive Radical Cystectomy With Ileal Conduit

2020 ◽  
Author(s):  
Ming Xiao ◽  
Zhaohui Zhong ◽  
Jiannan Ren ◽  
Wei Xiong
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Univariate Analysis ◽  
Comprehensive Complication Index ◽  
Estimated Blood Loss ◽  
Independent Risk Factors

Abstract Background: To investigate the risk factors for severe complications within 30 days in patients receiving minimally invasive radical cystectomy with ileal conduit(MIRCIC).Methods: 270 consecutive patients who underwent MIRCIC between January 1, 2013 and August 1, 2020 were included. All complications were graded according to the Clavien-Dindo classification(CDC). The comprehensive complication index(CCI) for all complications in each patient was calculated. CDC ≥ Ⅲ or CCI > 33.7 were considered to be severe complications. Univariate and multivariate analysis were conducted by SPSS26.Results: A total of 691 complications were collected from 236 patients and the corresponding overall complications rate was 87.41% (236/270). Patients with CDC ≥ Ⅲ accounted for 23.70% and the incidence of CCI > 33.7 was 22.96%. For the highest CDC grade ≥ Ⅲ, in univariate analysis, the following seven variants were enrolled in a multivariate analysis: BMI (P=0.010), baseline albumin(P=0.065), pT (P=0.082), pN (P=0.026), pTNM (P=0.016), intraoperative blood transfusion (P=0.031), estimated blood loss (P=0.001). In multivariate analysis, BMI ≥ 30kg/m2 (P=0.012) and estimated blood loss ≥ 400ml (P=0.005) were the independent risk factors of CDC ≥ Ⅲ. Hydronephrosis (P=0.050), BMI (P=0.006), pT (P=0.004), pN (P=0.019), pTNM (P=0.000), operative time (P=0.030), estimated blood loss (P=0.001) were the relevant factors in CCI > 33.7. However, BMI ≥ 30kg/m2 (P=0.004) and estimated blood loss (P=0.002) were the independent risk factors of CCI > 33.7.Conclusion: BMI ≥ 30kg/m2 and estimated blood loss ≥ 400ml were found to be independent predictors of 30-d severe complications (CDC ≥ Ⅲ or CCI > 33.7) in patients who underwent MIRCIC.

scholarly journals Preoperative CT anthropometric measurements and pancreatic pathology increase risk for postoperative pancreatic fistula in patients following pancreaticoduodenectomy

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243515
Author(s):  
Yun Hwa Roh ◽  
Bo Kyeong Kang ◽  
Soon-Young Song ◽  
Chul-Min Lee ◽  
Yun Kyung Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
International Study ◽  
Multivariate Regression Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Increase Risk ◽  
Preoperative Ct ◽  
Independent Risk Factors ◽  
Definition Of ◽  
Pancreatic Pathology

Postoperative pancreatic fistula (POPF) is a common complication following pancreaticoduodenectomy (PD). However, risk factors for this complication remain controversial. We conducted a retrospective analysis of 107 patients who underwent PD. POPF was diagnosed in strict accordance with the definition of the 2016 update of pancreatic fistula from the International Study Group on Pancreatic Fistula (ISGPF). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POPF. A total of 19 (17.8%) subjects of pancreatic fistula occurred after PD, including 15 (14.1%) with grade B POPF and 4 (3.7%) with grade C POPF. There were 33 (30.8%) patients with biochemical leak. Risk factors for POPF (grade B and C) were larger area of visceral fat (odds ratio [OR], 1.40; p = 0.040) and pathology other than pancreatic adenocarcinoma or pancreatitis (OR, 12.45; p = 0.017) in the multivariate regression analysis. This result could assist the surgeon to identify patients at a high risk of developing POPF.

scholarly journals Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion

2020 ◽  
Author(s):  
Yuanxing Zhou ◽  
Jianlong Deng ◽  
Xin Fu ◽  
Ming Yang ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Linear Regression ◽  
Blood Loss ◽  
Interbody Fusion ◽  
Fibrinogen Level ◽  
Muscle Thickness ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Hidden Blood Loss ◽  
Independent Risk Factors

Abstract Background Hidden blood loss (HBL) is still not well known or used in the setting of spine surgery. Elucidating absolute and relative amount of HBL is of great importance in order to avoid potential complications. Therefore, we evaluated HBL and its possible risk factors among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases. Methods Between June 2018 and March 2019, 137 consecutive patients with lumbar degenerative disease, who underwent operation with MIS-TLIF technique were enrolled in this study. The patient’s demographic characteristics and blood loss related parameters were collected respectively. Pearson or Spearman correlations analysis were used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was used to confirmed independent risk factors of HBL. Results A total of 137 patients (86 males and 51 females, age range 19-78 years) were reviewed in our hospital. A substantial amount of HBL (488.4±294.0 ml, 52.5% of TBL) occurred after MIS-TLIF. Multivariate linear regression showed that the age, muscle thickness, The Patients’ Society of Anesthesiologists (ASA) classification, patient’s blood volume (PBV), total blood loss (TBL), postoperative(i.e., day 2 or 3) hematocrit (Hct), Hct loss, and fibrinogen level were independent risk factors for HBL (P1=0.000, P2=0.002, P3=0.006, P4=0.002, P5=0.003, P6=0.048, P7=0.004, P8=0.070). Conclusion A large amount of HBL was incurred in patients undergoing MIS-TLIF. More importantly, the age, muscle thickness, ASA classification, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen level were independent risk factors for HBL in MIS-TLIF. HBL and its risk factors should be paid more attention to during perioperative period.

scholarly journals Comprehensive Diagnostic Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy

2021 ◽  
Vol 11 ◽  
Author(s):  
Bo Li ◽  
Ning Pu ◽  
Qiangda Chen ◽  
Yong Mei ◽  
Dansong Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Predictive Value ◽  
Predictive Accuracy ◽  
Postoperative Pancreatic Fistula ◽  
Diagnostic Model ◽  
Discriminative Ability ◽  
Reactive Protein ◽  
Independent Risk Factors ◽  
Drain Amylase

BackgroundClinically relevant postoperative pancreatic fistula (CR-POPF) remains a severe and challenging complication of pancreaticoduodenectomy (PD). This study aimed to establish a novel postoperative nomogram-based diagnostic model for the early detection of CR-POPF in patients subjected to PD.MethodsConsecutive patients who underwent PD in Zhongshan Hospital, Fudan University from December 2018 to October 2020 were retrospectively enrolled. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for CR-POPF. Then, a novel predictive nomogram was established accordingly.ResultsAmong the consecutive 176 patients who underwent PD, 37 (21.1%) patients developed CR-POPF. Through univariate and multivariate analyses, the drain amylase (P = 0.002), serum creatinine (P = 0.009), and serum C reactive protein (P = 0.045) at postoperative day 1 (POD1) as well as the neutrophil count (P = 0.025) and temperature (P = 0.025) at POD3 were identified as independent risk factors for CR-POPF. Based on this, a novel predictive nomogram containing these factors was constructed to predict the probability of CR-POPF after PD. The formulated nomogram showed better performance to detect CR-POPF after PD with a sensitivity of 0.784, specificity of 0.770, positive predictive value of 0.475, and negative predictive value of 0.930 when compared to other predictors. In addition, the predictive value of the nomogram was assessed by a concordance index of 0.814 (95% CI, 0.736–0.892), which was significantly higher than indicators alone. This was further validated and depicted by decision curve analysis and clinical impact curve.ConclusionThis study established a diagnostic nomogram of postoperative objective parameters that can predict the development of CR-POPF after PD with a good discriminative ability and predictive accuracy.

Sign in / Sign up

Export Citation Format

Share Document