Document Detail

Contemporary experience with postpancreatectomy hemorrhage: results of 1,122 patients resected between 2006 and 2011.
MedLine Citation:
PMID:  22921325     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication of pancreatic resection. Most published series span decades and do not reflect contemporary practice. This study analyzes the rate, management, and outcomes of PPH during a recent 5-year period.
STUDY DESIGN: Patients in whom PPH developed between 2006 and 2011 were identified from a prospective database. Postpancreatectomy hemorrhage was defined as evidence of bleeding associated with a drop in hemoglobin (≥ 3 g/dL) and/or clinical signs of hemodynamic compromise, and categorized as early or late (<24 hours or >24 hours from operation). Demographics and operative and perioperative outcomes were analyzed using standard descriptive statistics.
RESULTS: Overall incidence of PPH was 3% (33 of 1,122 pancreatectomies) and was similar for pancreaticoduodenectomy (25 of 739 [3%]), distal (6 of 350 [2%]), and central pancreatectomy (2 of 31 [6%]) (p = 0.26). Early hemorrhage was seen in 21% (7 of 33) and was always extraluminal; these patients underwent reoperation and recovered fully. Late hemorrhage (26 of 33 [79%]) was predominantly intraluminal (18 of 26 [69%]), occurring at a median of 12 days postoperatively (4 to 23 days), and was treated endoscopically (13 of 26 [50%]), angiographically (10 of 26 [38%]), or surgically (3 of 26 [10%]). Postpancreatectomy hemorrhage was associated with longer hospitalization (10 [range 8 to 17] days vs 7 [range 6 to 9] days; p < 0.01); mortality, however, was not increased (1 of 33 [3%] vs 17 of 1,089 [2%]; p = 0.95). Hemorrhage began after discharge in 39% of patients (13 of 33), with the only death occurring in a patient from this group.
CONCLUSIONS: Postpancreatectomy hemorrhage can be managed successfully with low mortality (3%). Early hemorrhage requires urgent reoperation, and management of delayed hemorrhage should be guided by location (intra- vs extraluminal). Greater pressure to reduce length of hospital stay appears to have increased the likelihood of PPH occurring after discharge; patients and physicians should be aware of this possibility.
Camilo Correa-Gallego; Murray F Brennan; Michael I D'Angelica; Ronald P DeMatteo; Yuman Fong; T Peter Kingham; William R Jarnagin; Peter J Allen
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2012-08-24
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  215     ISSN:  1879-1190     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-22     Completed Date:  2012-12-27     Revised Date:  2013-03-28    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  616-21     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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MeSH Terms
Follow-Up Studies
Hemostatic Techniques
Length of Stay
Middle Aged
Postoperative Hemorrhage* / diagnosis,  epidemiology,  etiology,  therapy
Retrospective Studies
Severity of Illness Index
Time Factors
Treatment Outcome
Comment In:
J Am Coll Surg. 2013 Mar;216(3):508-9   [PMID:  23415407 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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