Evidence map›Paper›PMID 22760965›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2012

Risk of morbidity and mortality following hepato-pancreato-biliary surgery.

Peter J Kneuertz, Henry A Pitt, Karl Y Bilimoria, Jill P Smiley, Mark E Cohen, Clifford Y Ko, Timothy M Pawlik

Abstract read
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In one paragraph

Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 121 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
121citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

121 citing papers in PubMed, 8 syntheses or guidelines pooled it.

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  8. Calculating the risk of a pancreatic fistula after a pancreaticoduodenectomy: a systematic review.HPB : the official journal of the International Hepato Pancreato Biliary Association · 2015
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61 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Peter J KneuertzDepartment of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Harvey 611, Baltimore, MD 21287, USA.
Henry A Pitt
Karl Y Bilimoria
Jill P Smiley
Mark E Cohen
Clifford Y Ko
Timothy M Pawlik

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionHepatic, pancreatic, and complex biliary (HPB) surgery can be associated with major morbidity and significant mortality. For the past 5 years, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has gathered robust data on patients undergoing HPB surgery. We sought to use the ACS-NSQIP data to determine which preoperative variables were predictive of adverse outcomes in patients undergoing HPB surgery.

methodsData collected from ACS-NSQIP on patients undergoing hepatic, pancreatic, or complex biliary surgery between 2005 and 2009 were analyzed (n = 13,558). Diagnoses and surgical procedures were categorized into 10 and eight groups, respectively. Seventeen preoperative clinical variables were assessed for prediction of 30-day postoperative morbidity and mortality. Multivariate logistic regression was utilized to develop a risk model.

resultsOf the 13,558 patients who underwent an HPB procedure, 7,321 (54%) had pancreatic, 4,881 (36%) hepatic, and 1,356 (10%) biliary surgery. Overall, 70.3% of patients had a cancer diagnosis. Post-operative complications occurred in 3,850 patients for an overall morbidity of 28.4%. Serious complications occurred in 2,522 (18.6%) patients; 366 patients died for an overall peri-operative mortality of 2.7%. Peri-operative outcome was associated with diagnosis and type of procedure. Hepatic trisectionectomy (5.8%) and total pancreatectomy (5.4%) had the highest 30-day mortality. Of the preoperative variables examined, age >74, dyspnea with moderate exertion, steroid use, prior cardiac procedure, ascites, and pre-operative sepsis were associated with morbidity and mortality (all P < 0.05).

conclusionsWhile overall morbidity and mortality for HPB surgery are low, peri-operative outcomes are heterogeneous and depend on diagnosis, procedure type, and key clinical factors. By combining these factors, an ACS-NSQIP "HPB Risk Calculator" may be developed in the future to help better risk-stratify patients being considered for complex HPB surgery.

Indexed as

AgedAged, 80 and overDigestive System DiseasesDigestive System Surgical ProceduresFemaleHumansMaleMiddle AgedMorbidityRisk Factors

Identifiers

PMID22760965

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.