Patient-specific predictors of failure to rescue after pancreaticoduodenectomy

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
Elizabeth M GleesonHenry A Pitt

Abstract

Failure to rescue (FTR) is a recently described outcome metric for quality of care. However, predictors of FTR have not been adequately investigated, particularly after pancreaticoduodenectomy. We aim to identify predictors of FTR after pancreaticoduodenectomy. We reviewed all patients who developed serious morbidity after pancreaticoduodenectomy from 2005 to 2012 in the ACS-NSQIP database. Logistic regression was used to identify preoperative and postoperative risks for 30-day mortality within a development cohort (randomly selected 80%). A score was created using weighted beta coefficients. Predictive accuracy was assessed on the validation cohort (remaining 20%) using a receiver operator characteristic curve and calculating the area under the curve (AUC). The FTR rate was 7.2% after pancreaticoduodenectomy (n = 5,027). We identified 5 independent risk factors: age ≥65 and albumin ≤3.5 g/dL, preoperatively; and development of shock, renal failure, and reintubation, postoperatively. The generated score had an AUC = 0.83 (95% CI, 0.77-0.89) in the validation cohort. Using the score: 1*Albumin ≤3.5 g/dL + 2*Age ≥ 65 + 2*Shock + 5*Renal failure + 5*Reintubation, FTR rates increased with increasing score (p < 0.001). FTR rates hav...Continue Reading

Citations

Mar 11, 2020·Expert Review of Neurotherapeutics·Antonella RivaPasquale Striano
May 15, 2020·The Journal of Surgical Research·Adam RoussasBellal Joseph
Sep 15, 2019·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Jonathan C WelchHenry A Pitt
Mar 21, 2021·Surgery·Anouk E J LatensteinUNKNOWN Global Audits on Pancreatic Surgery Group (GAPASURG)
Jun 17, 2021·Annals of Surgery·Elizabeth M GleesonUNKNOWN Global Audits on Pancreatic Surgery Group (GAPASURG)

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