Analysis of risk factors for reoperation after pancretoduodenectomy

Abstract

Objective To investigate the risk factors for reoperation after pancreaticoduodenectomy (Whipple). Methods Clinical data of 339 patients who underwent Whipple in the First Affiliated Hospital of Sun Yat-sen University from January 2000 to December 2009 were analyzed retrospectively. The informed consents of all patients or relatives were obtained and the ethical committee approval was received. There were 206 males and 133 females with age ranging from 1 to 86 years old and the median age of 55 years old. According to whether the patients received reoperation after operation, they were divided into reoperation group (n=24) and non-reoperation group (n=315). The reoperation of patients and its risk factors were analyzed. The relations between reoperation and clinical parameters were analyzed using Chi-square test and the risk factors for reoperation were analyzed using Logistic regression analysis. Results The reoperation rate of patients was 7.1% (24/339). The main causes of reoperation included abdominal bleeding (n=8, 5 cases were complicated with pancreatic fistula), upper gastrointestinal bleeding (n=7, 2 cases were complicated with pancreatic fistula), pancreatic fistula complicated with abdominal infection (n=2), biliary leakage (n=1) and wound rupture (n=6). In 24 patients receiving reoperation, 9 cases were related with pancreatic fistula. Four out of 5 death cases were with pancreatic fistula. The reoperation was related to preoperative diabetes, intraoperative blood loss (χ2=5.588, 4.565; P 400 ml were independent risk factors for reoperation after Whipple (OR=5.80, 2.74; P<0.05). Conclusions The main causes of reoperation after Whipple are pancreatic fistula and wound rupture. Preoperative diabetes, intraoperative blood loss>400 ml are independent risk factors for reoperation after Whipple. Key words: Pancreaticoduodnectomy; Reoperation; Risk factors; Blood loss, surgical; Diabetes mellitus