Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy

Abstract

Objective To analyze the Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and investigate the relationship between the major risk factors and Clavien-Dindo classification of complications. Methods The retrospective case-control study was adopted. The clinical data of 200 patients who underwent pancreaticoduodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected. The patients underwent Whipple surgery or pyloros-preserving pancreaticoduodenectomy according to the tumor location. Observation indicators included: (1) postoperative complications using Clavien-Dindo classification, (2) univariate and multivariate analyses: the basic conditions of patients, surgery-related factors, pancreas-related factors, (3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy. The univariate analysis and count data were done using the chi-square test. The comparison between groups was done using independent samples nonparametric test (Kolmogorov-Smirnov Z) and multivariate analysis was done using the Logistic regression model. Results (1) Postoperative complication situations: of 200 patients, 122 underwent Whipple surgery and 78 underwent pylorus-preserving pancreatico-duodenectomy, including 6 combined with vascular reconstruction and 1 with radiofrequency ablation of liver tumors. Ninety-eight patients had postoperative complications, including 41 patients with 2 or above kinds of complications. Pancreatic fistula was detected in 80 patients, including 42 with grade A, 28 with grade B and 10 with grade C, wound infection in 29 patients, delayed gastric emptying in 24 patients, postoperative intra-abdominal infection in 16 patients, postoperative intra-abdominal hemorrhage in 10 patients including 8 receiving interventional treatment, postoperative biliary leakage in 7 patients and unintended reoperation in 2 patients. Three patients were dead during hospitalization. The incidence of complications in gradeⅠ, Ⅱ, Ⅲ (Ⅲa and Ⅲb), Ⅳ and V of Clavien-Dindo classification was 28.00%(56/200), 13.00%(26/200), 5.00%(10/200), 1.50%(3/200) and 1.50%(3/200). (2) The univariate and multivariate analyses: the results of univariate analysis showed that body mass index (BMI) and texture of the pancreas were risk factors affecting complications after pancreatico-duodenectomy (χ2=6.483, Z=-3.189, P 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR=2.044, 1.649, 95% confidence interval: 1.212-3.447, 1.194-2.275). (3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed, there were statistically significant differences between BMI or texture of the pancreas and Clavien-Dindo classification of complications after pancreaticoduodenectomy (χ2=13.897, 27.077, P<0.05). Conclusions Clavien-Dindo classification of complications after pancreaticoduodenectomy is in favor of comprehensive comparisons and quality assessments among different studies, the primary classification is gradeⅠand Ⅱ. And decreasing BMI and good management of pancreatic stump may affect Clavien-Dindo classification of complications after pancreaticoduodenectomy. Key words: Pancreatic diseases; Pancreaticoduodenectomy; Surgical procedures, operative; Postoperative complications; Risk factors; Clavien-Dindo classification