The Beneficial Effects of Minimizing Blood Loss in Pancreatoduodenectomy

Annals of Surgery
Thomas F SeykoraPancreas Fistula Study Group

Abstract

The aim of this study was to elucidate the impact of intraoperative blood loss on outcomes following pancreatoduodenectomy (PD). 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. 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, and >1300 mL) using optimal scaling methodology. Multivariable regression, adjusted for patient, surgeon, and institutional variables, was used to identify associations between EBL and perioperative outcomes. Factors associated with both increased and decreased EBL were elucidated. The relative impact of surgeon-modifiable contributors was estimated through beta coefficient standardization. The median EBL of the series was 400 mL [interquartile range (IQR) 250 to 600]. Intra-, post-, and perioperative transfusion rates were 15.8%, 24.8%, and 37.2%, respectively. Progressive EBL zones correlated with intra- but not postoperative transfusion in a dose-dependent fashion (P < 0.001), with a key threshold of 750 mL EBL (8.14% vs 40.9%; P < 0.001). Increasing blood loss ...Continue Reading

References

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Citations

Oct 18, 2018·Journal of Hepato-biliary-pancreatic Sciences·Feng YangDeliang Fu
Aug 26, 2019·Langenbeck's Archives of Surgery·Florian OehmeThilo Welsch
Apr 22, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Nicolas TabchouriAlain Sauvanet
Jun 26, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Alexander M FagensonKwan N Lau
Nov 21, 2020·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Kenei FurukawaToru Ikegami
Oct 23, 2020·Annals of Surgical Oncology·George Van Buren, Charles M Vollmer
Jun 17, 2020·Annals of Surgery·Maxwell T TrudeauUNKNOWN on the behalf of the Pancreas Fistula Study Group

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