Preoperative coagulation abnormalities as a risk factor for adverse events after pancreas surgery

Area of Science:

• Surgical outcomes research
• Coagulation diagnostics
• Pancreatic surgery

Background:

• Elective pancreatectomy carries significant postoperative risks.
• Predictive markers for adverse events are crucial for patient management.

Purpose of the Study:

• To investigate if elevated International Normalized Ratio (INR) or Prothrombin Time (PTT) predict 30-day adverse events after elective pancreatectomy.
• To assess the association between prolonged bleeding times and postoperative morbidity and mortality.

Main Methods:

• Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2013).
• Inclusion of 14,747 patients undergoing elective pancreatectomy.
• Multivariate logistic regression to examine the association of elevated INR/PTT with 30-day outcomes.

Main Results:

• A significant increase in 30-day mortality was observed in patients with elevated INR/PTT (1.8% vs. 3.3%).
• Elevated INR/PTT correlated with increased odds of bleeding, surgical site infections, sepsis, respiratory complications, cardiac events, renal failure, reoperation, and prolonged hospital stay.
• These associations remained significant after controlling for confounders, except for superficial surgical site infections.

Conclusions:

• Prolonged bleeding times (elevated INR/PTT) are linked to higher mortality and adverse outcomes post-pancreas surgery.
• Coagulation profiles, specifically INR and PTT, can serve as valuable tools for risk stratification in patients undergoing pancreatectomy.
• Identifying high-risk patients allows for targeted resource allocation and potentially improved patient care.