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Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy.

Publication ,  Journal Article
Araujo, RLC; Karkar, AM; Allen, PJ; Gönen, M; Chou, JF; Brennan, MF; Blumgart, LH; D'Angelica, MI; DeMatteo, RP; Coit, DG; Fong, Y; Jarnagin, WR
Published in: HPB (Oxford)
March 2014

OBJECTIVES: The timing of major elective operations is a potentially important but rarely examined outcome variable. This study examined elective pancreaticoduodenectomy (PD) timing as a perioperative outcome variable. METHODS: Consecutive patients submitted to PD were identified. Determinants of 90-day morbidity (prospectively graded and tracked), anastomotic leak or fistula, and mortality, including operation start time (time of day), day of week and month, were assessed in univariate and multivariate analyses. Operation start time was analysed as a continuous and a categorical variable. RESULTS: Of the 819 patients identified, 405 (49.5%) experienced one or more complications (total number of events = 684); 90-day mortality was 3.5%. On multivariate analysis, predictors of any morbidity included male gender (P = 0.009) and estimated blood loss (P = 0.017). Male gender (P = 0.002), benign diagnosis (P = 0.002), presence of comorbidities (P = 0.002), American Society of Anesthesiologists (ASA) score (P = 0.025), larger tumour size (P = 0.013) and positive resection margin status (P = 0.005) were associated with the occurrence of anastomotic leak or fistula. Cardiac and pulmonary comorbidities were the only variables associated with 90-day mortality. Variables pertaining to procedure scheduling were not associated with perioperative morbidity or mortality. Operation start time was not significant when analysed as a continuous or a categorical variable, or when stratified by surgeon. CONCLUSIONS: Perioperative outcome after PD is determined by patient, disease and operative factors and does not appear to be influenced by procedure timing.

Duke Scholars

Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

March 2014

Volume

16

Issue

3

Start / End Page

250 / 262

Location

England

Related Subject Headings

  • Workload
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Postoperative Complications
  • Personnel Staffing and Scheduling
 

Citation

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Araujo, R. L. C., Karkar, A. M., Allen, P. J., Gönen, M., Chou, J. F., Brennan, M. F., … Jarnagin, W. R. (2014). Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy. HPB (Oxford), 16(3), 250–262. https://doi.org/10.1111/hpb.12107
Araujo, Raphael L. C., Ami M. Karkar, Peter J. Allen, Mithat Gönen, Joanne F. Chou, Murray F. Brennan, Leslie H. Blumgart, et al. “Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy.HPB (Oxford) 16, no. 3 (March 2014): 250–62. https://doi.org/10.1111/hpb.12107.
Araujo RLC, Karkar AM, Allen PJ, Gönen M, Chou JF, Brennan MF, et al. Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy. HPB (Oxford). 2014 Mar;16(3):250–62.
Araujo, Raphael L. C., et al. “Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy.HPB (Oxford), vol. 16, no. 3, Mar. 2014, pp. 250–62. Pubmed, doi:10.1111/hpb.12107.
Araujo RLC, Karkar AM, Allen PJ, Gönen M, Chou JF, Brennan MF, Blumgart LH, D’Angelica MI, DeMatteo RP, Coit DG, Fong Y, Jarnagin WR. Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy. HPB (Oxford). 2014 Mar;16(3):250–262.
Journal cover image

Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

March 2014

Volume

16

Issue

3

Start / End Page

250 / 262

Location

England

Related Subject Headings

  • Workload
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Postoperative Complications
  • Personnel Staffing and Scheduling