Journal of Surgery Concepts & Practice ›› 2023, Vol. 28 ›› Issue (02): 139-146.doi: 10.16139/j.1007-9610.2023.02.10
• Original article • Previous Articles Next Articles
YU Lana,b, ZHANG Yongyia,b(), HUANG Leic, WAN Xind, JIANG Shengyaod, TANG Sijinga, ZHANG Junc, HU Weiguoe
Received:
2022-06-01
Online:
2023-03-25
Published:
2023-06-06
CLC Number:
YU Lan, ZHANG Yongyi, HUANG Lei, WAN Xin, JIANG Shengyao, TANG Sijing, ZHANG Jun, HU Weiguo. Risk factors of severe postoperative complications in elderly patients with pancreaticoduodenectomy[J]. Journal of Surgery Concepts & Practice, 2023, 28(02): 139-146.
Tab 1
Characteristics of patients with or without severe complications [ x±s/n(%)/M(Q1,Q3)]
Item | Total(n=399) | Severe complication | χ2/Z/t value | P value | |
---|---|---|---|---|---|
Yes(n=37) | No(n=362) | ||||
Gender | |||||
Male | 233 (58.4) | 24 (64.9) | 209 (57.7) | 0.70 | 0.40 |
Female | 166 (41.6) | 13 (35.1) | 153 (42.3) | ||
Age≥75 years | 76 (19.0) | 14 (37.8) | 62 (17.1) | 9.34 | <0.001a) |
Age (years) | 70.6 ± 4.7 | 72.7 ± 6.2 | 70.4 ± 4.4 | 2.22 | 0.03 a) |
With diabetes | 123 (30.8) | 12 (32.4) | 111 (30.7) | 0.05 | 0.82 |
With hypertension | 215 (53.9) | 27 (73.0) | 157 (43.4) | 11.84 | <0.001a) |
Domicile | |||||
Shanghai | 197 (49.4) | 24 (64.9) | 173 (47.8) | 4.14 | 0.24 |
Jiangsu | 69 (17.3) | 5 (13.5) | 64 (17.7) | ||
Zhejiang | 56 (14.0) | 4 (10.8) | 52 (14.3) | ||
Others | 77 (19.3) | 4 (10.8) | 73 (20.2) | ||
Barthel index score | 77.8 ± 7.6 | 74.3 ± 14.4 | 78.2 ± 6.4 | 2.98 | <0.001a) |
Operative type | |||||
Open pancreatoduodenectomy | 329 (82.5) | 34 (91.9) | 295 (81.5) | 2.51 | 0.11 |
Da Vinci robot operation | 70 (17.5) | 3 (8.1) | 67 (18.5) | ||
Surgical procedure | |||||
Pancreatoduodenectomy | 351 (88.0) | 29 (78.4) | 322 (89.0) | 3.55 | 0.06 |
Complex pancreatoduodenectomy | 48 (12.0) | 8 (21.6) | 40 (11.0) | ||
Operative time (min) | 310 (265,365) | 330 (290,393) | 305 (261,360) | 1.91 | 0.05 |
Intraoperative blood loss(mL) | 400 (300,600) | 500 (300,800) | 400 (300,600) | 1.32 | 0.19 |
Tumor location | |||||
Pancreas | 311 (77.9) | 30 (81.1) | 281 (77.6) | 0.23 | 0.62 |
Others | 88 (22.1) | 7 (18.9) | 81 (22.4) | ||
Pathological classification | |||||
Adenocarcinoma | 337 (84.5) | 33 (89.2) | 304 (84.0) | 0.70 | 0.40 |
Others | 62 (15.5) | 4 (10.8) | 58 (16.0) | ||
Preoperative nutritional risk | 286 (71.7) | 29 (78.4) | 257 (71.0) | 0.90 | 0.34 |
ALB on admission (g) | 37.3 ± 5.3 | 36.4 ± 5.6 | 37.4 ± 5.3 | 0.89 | 0.37 |
HB on admission (g) | 124.1 ± 17.8 | 122.0 ± 21.8 | 124.3 ± 17.4 | 0.63 | 0.53 |
Postoperative hospital stay (d) | 21.8 ± 11.9 | 28.4 ± 15.4 | 21.1 ± 11.3 | 2.84 | <0.001a) |
Total hospital stay (d) | 29.2 ± 12.8 | 37.4 ± 16.3 | 28.3 ± 12.2 | 4.42 | <0.001a) |
Cost in hospital stay (×10 000 RMB) | 10.9 ± 4.5 | 15.1 ± 6.1 | 10.4 ± 4.1 | 4.50 | <0.001 a) |
Tab 2
Risk factors of severe postoperative complications of elderly patients with PD
Item | OR (95% CI) | P value | |
---|---|---|---|
Gender | Male | 1(reference) | |
Female | 0.58 (0.25-1.33) | 0.19 | |
Age | <75 years | 1(reference) | |
≥75 years | 2.78 (1.20-6.42) | 0.02a) | |
With hypertension | Yes | 4.20 (1.82-9.71) | <0.001a) |
No | 1(reference) | ||
With diabetes | Yes | 0.76 (0.33-1.73) | 0.51 |
No | 1(reference) | ||
Tumor location | Pancreas | 1(reference) | |
Others | 0.78 (0.28-2.16) | 0.63 | |
Pathological classification | Adenocarcinoma | 1(reference) | |
Others | 0.94 (0.30-2.97) | 0.92 | |
Preoperative nutritional risk | Yes | 2.42 (0.96-6.13) | 0.06 |
No | 1(reference) | ||
Surgical procedure | Pancreatoduodenectomy | 1(reference) | |
Complex pancreatoduodenectomy | 1.77 (0.66-4.76) | 0.63 | |
Operative type | Open pancreatoduodenectomy | 1(reference) | |
Da Vinci robot operation | 0.48 (0.13-1.71) | 0.25 | |
Domicile | Shanghai | 1(reference) | |
Jiangsu | 0.50 (0.16-1.47) | 0.21 | |
Zhejiang | 0.56 (0.16-1.97) | 0.37 | |
Others | 0.49 (0.15-1.59) | 0.23 | |
ALB on admission | 1.02 (0.93-1.11) | 0.74 | |
HB on admission | 0.99 (0.98-1.03) | 0.96 | |
Barthel index score | 0.96 (0.93-0.99) | 0.01a) | |
Operative time | 1.01 (0.99-1.02) | 0.12 | |
Intraoperative blood loss | 1.00 (0.99-1.00) | 0.82 |
Tab 3
Interactions among surgical procedure, operative type, operative time and intraoperative blood loss on severe post-operative complications
Variables | β | SE | Wald χ2 | P value | OR(95%CI) |
---|---|---|---|---|---|
Interaction between surgical procedure and operative type | -0.026 | 0.344 | 0.006 | 0.940 | 0.974(0.497-1.912) |
Interaction between surgical procedure and operative time | 0.002 | 0.001 | 3.045 | 0.081 | 1.002(1.000-1.004) |
Interaction between surgical procedure and intraoperative blood loss | 0.000 | 0.000 | 0.244 | 0.621 | 1.000(0.999-1.001) |
Interaction between operation type and operative time | -0.002 | 0.002 | 1.098 | 0.295 | 0.998(0.995-1.002) |
Interaction between operative type and intraoperative blood loss | 0.000 | 0.001 | 0.239 | 0.625 | 1.000(0.998-1.001) |
Interaction between operative time and intraoperative blood loss | 0.000 | 0.000 | 1.949 | 0.163 | 1.000(1.000-1.000) |
Tab 4
Logistic regression analysis of risk factors of severe postoperative complications of ederly patients with PD (backward)
Variables | OR(95%CI) | P value |
---|---|---|
Age | 0.01a | |
≥75 years | 2.67 (1.24-5.74) | |
<75 years | 1 (reference) | |
With hypertension | 0.00a | |
Yes | 3.85 (1.74-8.53) | |
No | 1 (reference) | |
Preoperative nutritional risk | 0.09 | |
Yes | 2.13 (0.89-5.13) | |
No | 1 (reference) | |
Operative type | 0.13 | |
Da Vinci robot operation | 0.38 (0.11-1.31) | |
Open pancreatoduodenectomy | 1 (reference) | |
Barthel index score | 0.97 (0.94-1.00) | 0.03a) |
Operative time | 1.00 (1.00-1.01) | 0.04a) |
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