Zentralbl Chir
DOI: 10.1055/a-1235-5871
Original Article/Originalarbeit

Risk Stratification for the Intensive Care Unit Following Pancreaticoduodenectomy

Article in several languages: English | deutsch
Steffen Deichmann
1  Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
,
Uwe Ballies
1  Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
,
Ekaterina Petrova
1  Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
,
Louisa Bolm
1  Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
,
Kim Honselmann
1  Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
,
Laura Frohneberg
1  Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
,
1  Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
,
Ulrich Friedrich Wellner
1  Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
,
Dirk Bausch
2  Department of General Surgery, Marien Hospital Herne – University Medical Center of Ruhr-University Bochum, Germany
› Author Affiliations

Abstract

Introduction In view of the limited capacities in intensive care units and the increasing economic burden, identification of risk factors could allow better and more efficient planning. Therefore, the aim of this study was to assess independent risk factors for the duration of intensive care unit stay after pancreatoduodenectomy (PD).

Methods 147 patients who underwent pancreatoduodenectomy in the time period from 2013 to 2015 were identified from a prospective database and a retrospective analysis was performed. The primary endpoint was length of time spent in the ICU. A retrograde analysis was performed using univariate and multivariate regression analysis. All pre-, intra- and postoperative parameters were considered in the analysis.

Results The median time spent in the intensive care unit (ICU) is one day. The univariate analysis demonstrated increased pack years, cerebrovascular events, anticoagulation, elevated creatinine and CA 19-9 as preoperative risk factors. In multivariate analysis, antihypertensive medication (AHT; OR 2.46; 95% CI 1.57 – 3.87; p = 0.05), operation time (OR 1.01; 95% CI 1.00 – 1.01; p = 0.03), extended LAD (OR 5.46; 95% CI 2.77 – 10.75; p = 0.01) and severe PPH (OR 4.01; 95% CI 2.07 – 7.76; p = 0.04) are significant risk factors for longer ICU stay.

Discussion Patients with cardiovascular risk factors and elevated preoperative creatinine level are at greater risk for a prolonged ICU stay. Risk and benefit of an extended LAD should be weighed during the operation. Median duration on ICU/IMC after PD is one day or less for patients without risk factors. Whether routine monitoring in the ICU/IMC after PD is necessary must be clarified in further studies.



Publication History

Publication Date:
12 October 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany