Mortality rates after pancreaticoduodenectomy have decreased dramatically during the last two decades in high volume centers. However, despite a low mortality rate and improvements in perioperative care, morbidity rate is still high after pancreaticoduodenectomy. Studies defining the role of potential risk factors for the development of postoperative complications are few, and sometimes with conflicting results. There is need to identify potential risk factors for predicting complications after pancreatic resections.
Aim: The aim of the present study was to assess the risk factors for morbidity after pancreatic resections, by utilizing a simple grading system and identify the factors affecting them.
Material and Methods: This was a prospective study done in the Department of Surgical Gastroenterology between Feb 2007 to Jun 2009. All patients who underwent elective pancreatic surgeries were included in this study.
Major Morbidity was defined as patients having grade III and above complications. The risk factors assessed were patient factors, disease factors, operative factors and postoperative factors. Risk factors were analyzed for morbidity and major morbidity separately.
Results: One Hundred and Seven patients underwent elective pancreatic surgeries between Feb 2007 to Jun 2009. Pancreaticoduodenectomy was the commonest procedure. Three patients died after pancreatic surgeries. Mortality rate after pancreatic surgery was 2.8% (3/107) and that after Whipple’s procedure was 4.68% (3/64).In our study a total of 58 of 107 (54.2%) patients developed complications after pancreatic surgery. Major morbidity defined as Grade III or more complication was seen in 24.2% (26/107). Complications after Whipple’s procedure was seen in 49 of 64 (76%) patients. Major morbidity (Grade III and more) was seen in 22 of 64 patients (34.3%). All complications following pancreatic surgeries were graded. The mean postoperative duration was 12.4 days (6 – 47 days).The significant risk factors for morbidity after pancreatic surgery were soft pancreas (OR 5.988; p=.007), SGPT > 73 U/L (OR 3.623; p = .054), age > 50yrs (OR 3.254; p = .053), and absence of chronic pancreatitis (OR 4.363, p = .016).The significant factors for major morbidity were soft pancreas (OR 6.557, p = .005), hypertension (OR 5.803, p = .037) and BMI >25(OR 4.052, p = .05).
1. Independent factors predicting morbidity after pancreatic surgery were soft pancreas, age > 50yrs, SGPT > 73 U/L and absence of chronic pancreatitis.
2. Independent factors predicting major morbidity after pancreatic surgery were soft pancreas, hypertension and BMI > 25.