Serum Blood Urea Nitrogen and Serum Albumin on the First Postoperative Day Predict Pancreatic Fistula and Major Complications After Pancreaticoduodenectomy

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• 作者：Daniel M. Relles (1) (3)
  Nathan G. Richards (1) (3)
  Jordan P. Bloom (1) (3)
  Eugene P. Kennedy (1) (3)
  Patricia K. Sauter (1) (3)
  Benjamin E. Leiby (2) (3)
  Ernest L. Rosato (1) (3)
  Charles J. Yeo (1) (3)
  Adam C. Berger (1) (3) (4)
  
• 关键词：Pancreatic ductal adenocarcinoma ; Pancreaticoduodenectomy ; Pancreatic fistula ; Clavien scale ; Hypoalbuminemia ; Blood urea nitrogen
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2013
• 出版时间：February 2013
• 年：2013
• 卷：17
• 期：2
• 页码：326-331
• 全文大小：287KB
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• 作者单位：Daniel M. Relles (1) (3)
  Nathan G. Richards (1) (3)
  Jordan P. Bloom (1) (3)
  Eugene P. Kennedy (1) (3)
  Patricia K. Sauter (1) (3)
  Benjamin E. Leiby (2) (3)
  Ernest L. Rosato (1) (3)
  Charles J. Yeo (1) (3)
  Adam C. Berger (1) (3) (4)
  
  1. Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
  3. Jefferson Pancreas, Biliary and Related Cancer Center, Philadelphia, PA, USA
  2. Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA, USA
  4. Department of Surgery, Thomas Jefferson University, 1100 Walnut Street, MOB, Suite 500, Philadelphia, PA, 19107, USA
  

文摘

Introduction Pancreaticoduodenectomy (PD) has a high morbidity rate. Previous work has shown that hypoalbuminemia on postoperative day 1 (POD) to be contributory to post-esophagectomy complications. We set out to determine the impact of blood urea nitrogen (BUN) and albumin on POD 1 for patients undergoing PD. Methods We examined 446 consecutive patients who underwent PD at the Thomas Jefferson University Hospital between January 1, 2000 and December 31, 2008. Complications were graded using the Clavien scale. We examined the incidence of complications based on POD 1 albumin <2.5 versus ?.5?mg/dl, as well as POD 1 BUN <10 vs. ?0?g/dL. Results Patients with a BUN <10 had a significantly decreased risk of any complication (p-lt;-.001), serious complication (p-lt;-.001), and pancreatic fistula (p--.011). On multivariate analysis, BUN?≥-0 was the most significant predictor of grade III or above complication (p--.0019, hazard ration (HR)--.7) and pancreatic fistula (p--.016, HR--.6). POD 1 albumin <2.5?mg/dl was also an independent predictor of serious complication (p--.01, HR--.3). Patients with both risk factors had a 31?% chance of developing serious complications and 18.5?% risk of developing pancreatic fistula, while those patients with neither risk factor had a 6.5 and 3.6?% risk, respectively. Conclusion Serum albumin and BUN on POD 1 are important predictors of perioperative morbidity following PD. These low-cost and easily accessible tests can be used as a prognostic tool to predict adverse surgical outcomes.