The Impact of Complications after Pancreaticoduodenectomy in Elderly Patients: A Review of the Nationwide Inpatient Sample Database

摘要

Pancreaticoduodenectomy (PD) has emerged as the primary therapy for resectable periampullary tumors and diseases. The difference in the outcome after PD is multifactorial. Ongoing debates on the possible detrimental influence of these factors on postoperative outcome still persist. It is not clear whether there is a differential impact on mortality among the subset of patients experiencing complications after PD. Our study objective was to investigate potential demographic differences in mortality as well as factors that are associated with postoperative mortality in elderly patients with complications after PD. A retrospective analysis was conducted using the Nationwide Inpatient Sample (NIS) database1 for the years 1998 to 2009. Elderly patients aged 65 years or older who underwent PD as their primary procedure were selected using International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code 52.7. Those patients with record of at least one of three complications-acute pancreatitis, pancreatic fistula, or delayed gastric emptying-were further identified using ICD-9-CM codes 577.0, 577.8, and 536.8, respectively. Records of patients with an ICD-9-CM diagnosis codes for trauma were excluded from the cohort. Univariate and bivariate analyses were carried out to provide descriptive statistics. Pearson x2 test was used for categorical variables, whereas the analysis of variance was used for continuous variables. Multivar-iable logistic regression was used to assess the odds of postoperative mortality comparing racial/ethnic groups (with white as the reference) adjusting for patient characteristics, hospital factors, case mix, and discharge year. Sampling weights were applied. All statistical analyses were performed using STATA/MP Version 11.0 (Stata-Corp, College Station, TX). Statistical significance was set at P < 0.05. Overall, a total of 8060 patients who underwent PD met all our inclusion criteria. Among these, 721 (9%) patients, representing 3575 patients nationally, had at least one of the specific postoperative complications of interest. This morbid group was the focus of our study.