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Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy
Published on: November 20, 2021
Pancreatic Resection Operations in Pediatric Patients: A NSQIP-Pediatric Analysis of Outcomes and Factors Associated
Muhammed Ali Colak1, Shruthi Srinivas2, Yueran Zhang3
1Department of Abdominal Transplant and Hepatopancreatobiliary Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Insights
Preoperative comorbidities and the need for nutritional support significantly increase the risk of adverse events in pediatric patients undergoing pancreatic resections. Optimizing these factors before surgery is crucial for improving outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Health Services Research
Background:
- Pancreatic resections in children are complex procedures with potential for significant morbidity.
- Identifying factors that predict adverse events is essential for improving patient care and outcomes.
Purpose of the Study:
- To assess postoperative outcomes of pancreatic resection operations in pediatric patients.
- To identify factors associated with early postoperative adverse events in this population.
Main Methods:
- Retrospective cohort study using the National Surgical Quality Improvement Program-Pediatric database (2012-2021).
- Analysis of 336 children (age ≤18 years) undergoing various pancreatic resections.
- Multivariable logistic regression to identify predictors of 30-day postoperative adverse events.
Main Results:
- Distal pancreatectomy was the most common procedure (77.4%).
- Overall, 31.5% of patients experienced adverse events, including 8% readmissions and 6% reoperations.
- Preoperative comorbidities (aOR: 2.51) and need for nutritional support (aOR: 3.94) were independently associated with higher odds of adverse events.
Conclusions:
- Preoperative comorbidities and nutritional support requirements are key predictors of adverse events following pediatric pancreatectomy.
- Multidisciplinary preoperative optimization is recommended for high-risk pediatric surgical patients undergoing pancreatic resections.
Purpose:
We aim to utilize a large national database to assess postoperative outcomes of pancreatic resection operations in children and the factors associated with early postoperative adverse events.
Methods:
Children (age ≤18 years) undergoing pancreatectomy between 2012 and 2021 were identified using the National Surgical Quality Improvement Program-Pediatric database. Demographics, comorbidities, and outcomes were reported across operation types. Multivariable logistic regression was used to identify factors associated with postoperative adverse events within 30 days.
Results:
Of 336 patients identified, 260 (77.4 %) underwent distal pancreatectomy, 54 (16.1 %) underwent enucleation, 12 (3.6 %) underwent total pancreatectomy with islet autotransplantation, 5 (1.5 %) underwent pancreatoduodenectomy, 3 (0.9 %) underwent total pancreatectomy, and 2 (0.6 %) underwent debridement. Indications for operation included pancreatic neoplasms/cysts (n = 134, 39.9 %), hypoglycemia (n = 95, 28.3 %), other pancreatic diagnoses (n = 59, 17.6 %), pancreatitis/pseudocysts (n = 36, 10.7 %), and trauma (n = 12, 3.6 %). Median length of stay was 7 days (IQR: 5-15). In the 30-day postoperative period, 27 (8 %) patients were readmitted, 20 (6 %) patients underwent reoperation, 85 (25.3 %) patients had complications, and there was one (0.3 %) mortality. Overall, 106 (31.5 %) patients had postoperative adverse events. Odds of any adverse event were independently higher in those with preoperative comorbidities (adjusted odds ratio (aOR): 2.51, 95 % confidence interval (CI): 1.39-4.57) and need for preoperative nutritional support (aOR: 3.94, 95 % CI: 1.88-8.54).
Conclusion:
In pediatric patients undergoing pancreatectomy operations, preoperative comorbidities and need for nutritional support are independently associated with higher odds of adverse events. Multidisciplinary preoperative optimization should be considered in these high-risk groups.
Type Of Study:
Retrospective cohort study.
Level Of Evidence:
III.
