The effect of high intraoperative blood loss on pancreatic fistula development after pancreatoduodenectomy: An international, multi-institutional propensity score matched analysis.

Published on Apr 27, 2021in Surgery3.356
· DOI :10.1016/J.SURG.2021.03.044
Fabio Casciani2
Estimated H-index: 2
(UPenn: University of Pennsylvania),
Maxwell T. Trudeau3
Estimated H-index: 3
(UPenn: University of Pennsylvania)
+ 52 AuthorsRonald R. Salem29
Estimated H-index: 29
Abstract Background The association between intraoperative estimated blood loss and outcomes after pancreatoduodenectomy has, thus far, been rarely explored. Methods In total, 7,706 pancreatoduodenectomies performed at 18 international institutions composing the Pancreas Fistula Study Group were examined (2003–2020). High estimated blood loss (>700 mL) was defined as twice the median. Propensity score matching (1:1 exact-match) was employed to adjust for variables associated with high estimated blood loss and clinically relevant pancreatic fistula occurrence. The study was powered to detect a 33% clinically relevant pancreatic fistula increase in the high estimated blood loss group, with α = 0.05 and β = 0.2. Results The propensity score model included 966 patients with high estimated blood loss and 966 patients with lower estimated blood loss; all covariate imbalantces were solved. Patients with high estimated blood loss patients experienced higher clinically relevant pancreatic fistula rates (19.4 vs 12.6%, odds ratio 1.66; P Conclusion This study better establishes the relationship between estimated blood loss and outcomes after pancreatoduodenectomy. Despite inherent contributions to blood loss, its minimization is an actionable opportunity for clinically relevant pancreatic fistula reduction and performance optimization in pancreatoduodenectomy. Accordingly, practical insights are offered to achieve this goal.
#1Timothy H. Mungroop (UvA: University of Amsterdam)H-Index: 8
#2Sjors Klompmaker (UvA: University of Amsterdam)H-Index: 13
Last. Marc G. Besselink (UvA: University of Amsterdam)H-Index: 7
view all 17 authors...
OBJECTIVE: The aim of the study was to validate and optimize the alternative Fistula Risk Score (a-FRS) for patients undergoing minimally invasive pancreatoduodenectomy (MIPD) in a large pan-European cohort. BACKGROUND: MIPD may be associated with an increased risk of postoperative pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for lapa...
26 CitationsSource
#1Maxwell T. Trudeau (UPenn: University of Pennsylvania)H-Index: 3
#2Fabio Casciani (UPenn: University of Pennsylvania)H-Index: 2
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 25 authors...
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#1Thomas F. Seykora (UPenn: University of Pennsylvania)H-Index: 5
#2Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 18
Last. Charles M. VollmerH-Index: 67
view all 18 authors...
OBJECTIVE:The aim of this study was to elucidate the impact of intraoperative blood loss on outcomes following pancreatoduodenectomy (PD). BACKGROUND:The negative impact of intraoperative blood loss on outcomes in PD has long been suspected but not well characterized, particularly those factors that may be within surgeons' control. METHODS:From 2001 to 2015, 5323 PDs were performed by 62 surgeons from 17 institutions. Estimated blood loss (EBL) was discretized (0 to 300, 301 to 750, 751 to 1300,...
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#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 18
#2Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
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BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate perioperative outcomes and survival in patients undergoing an artery-first approach to pancreatoduodenectomy in comparison with those having standard pancreatoduodenectomy. METHODS: A systematic search of PubMed, MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed in accordance with PRISMA guidelines. Comparative studies including patients who underwent artery-first pancreatoduodenectomy and...
39 CitationsSource
#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 18
#2Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 35
view all 38 authors...
Objective:The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy.Background:The utility of technical strategies to prevent clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) may vary by the circ
62 CitationsSource
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