Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy
Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy
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DOI：
10.1016/j.surg.2016.09.028
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发表时间：
2017-04-01
期刊：
影响因子：
3.8
通讯作者：
Winter, Jordan M.
中科院分区：
文献类型：
--
作者：
Nagle, Ramzy T.;Leiby, Benjamin E.;Winter, Jordan M.
背景胰腺切除术的并发症发生率很高，在40- 60%之间。虽然许多特定的并发症已被广泛研究，术后肺炎很少受到关注。回顾性评估了2002年至2014年在托马斯杰斐逊大学医院接受胰腺切除术（n = 1，090）和远端胰腺切除术（n = 436）的患者的术后肺炎。确定发病率、预测因素和结局。胰腺癌切除术后4.3%的患者诊断为肺炎，胰腺远端切除术后2.5%的患者诊断为肺炎。大多数肺炎归因于吸入（分别为87.2%和81.8%）。胰管切除术组中的胰腺炎更常见（Clavien-Dindo 4级或5级），而胰尾切除术组中的胰腺炎更常见（55.3% vs 9.1%，P = .006）。胰腺癌术后肺炎的预测因素包括胃排空延迟（比值比8.2，P <0.001）、术后第3天需氧量（比值比3.2，P = 0.005）和慢性阻塞性肺疾病（比值比3.1，P = 0.049）。在胰腺切除术后组中，肺炎与90天死亡率非常高（29.8%比2.1%，P < .001），对胰腺切除术后死亡率的影响最大（比值比9.6，P < .001）。建立了胰腺炎术后肺炎的术前风险评分模型。胰管切除术后肺炎是一种罕见但高度病态的事件，与围手术期死亡的风险显著增加有关。
Background. Pancreatectomy is associated with a high complication rate that varies between 40-60%. Although many specific complications have been extensively studied, postoperative pneumonia has received little attention.Methods. Patients undergoing pancreaticoduodenectomy (n = 1,090) and distal pancreatectomy (n = 436) from 2002 to 2014 at Thomas Jefferson University Hospital were retrospectively assessed for postoperative pneumonia. Incidence, predictive factors, and outcomes were determined.Results. Pneumonia was diagnosed in 4.3% of patients after pancreaticoduodenectomy and 2.5% after distal pancreatectomy. The majority of the pneumonias were attributed to aspiration (87.2% and 81.8%, respectively). Pneumonias were more frequently severe (Clavien-Dindo grades 4 or 5) in the pancreaticoduodenectomy group compared to the distal pancreatectomy group (55.3% vs 9.1 %, P = .006). Post-pancreaticoduodenectomy pneumonia predictors included delayed gastric emptying (odds ratio 8.2, P < .001), oxygen requirement on postoperative day 3 (odds ratio 3.2, P = .005), and chronic obstructive pulmonary disease (odds ratio 3.1, P = .049). In the post-pancreaticoduodenectomy group, pneumonia was associated with a very high 90-day mortality compared with those who did not have pneumonia (29.8% vs 2.1 %, P < .001) and had the largest effect on mortality after pancreaticoduodenectomy (odds ratio 9.6, P < .001). A preoperative risk score model for pneumonia post-pancreaticoduodenectomy was developed.Conclusion. Pneumonia after pancreaticoduodenectomy is an uncommon but highly morbid event and is associated with a substantially increased risk of perioperative death.