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Patient-specific predictors of failure to rescue after pancreaticoduodenectomy
Journal article   Open access   Peer reviewed

Patient-specific predictors of failure to rescue after pancreaticoduodenectomy

Elizabeth M Gleeson, John R Clarke, William F Morano, Mohammad F Shaikh, Wilbur B Bowne and Henry A Pitt
HPB (Oxford, England), v 21(3), pp 283-290
Mar 2019
DOI: https://doi.org/10.1016/j.hpb.2018.07.022
PMID: 30143319
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.hpb.2018.07.022View
Published, Version of Record (VoR)Open Access (Publisher-Specific),  Open

Abstract

Aged Failure to Rescue, Health Care Female Humans Logistic Models Male Middle Aged Pancreatic Neoplasms - mortality Pancreatic Neoplasms - surgery Pancreaticoduodenectomy - adverse effects Postoperative Complications - epidemiology Retrospective Studies Risk Factors Treatment Outcome
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 have previously been shown to be associated with hospital factors. We show that FTR is also associated with preoperative and postoperative patient-specific factors.

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24 citations in Web of Science
23 citations in Scopus

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Gastroenterology & Hepatology
Surgery
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