Mortality and morbidity after pancreatoduodenectomy in patients undergoing hemodialysis: Analysis using a national inpatient database.

Authors:
Hiroji Shinkawa
Hiroji Shinkawa
Osaka City University Graduate School of Medicine
Japan
Hideo Yasunaga
Hideo Yasunaga
Graduate School of Medicine
Japan
Kiyoshi Hasegawa
Kiyoshi Hasegawa
Graduate School of Medicine
Japan
Hiroki Matsui
Hiroki Matsui
Mie University
Japan
Nobuaki Michihata
Nobuaki Michihata
School of Public Health
Kiyohide Fushimi
Kiyohide Fushimi
Kyushu University
Japan
Norihiro Kokudo
Norihiro Kokudo
Graduate School of Medicine
Japan

Surgery 2019 Apr 10;165(4):747-750. Epub 2018 Nov 10.

National Center for Global Health and Medicine, Tokyo, Japan.

Background: Whether patients undergoing hemodialysis have greater risks of mortality and morbidity after pancreatoduodenectomy remains unknown.

Methods: We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify patients who underwent pancreatoduodenectomy from July 2010 to March 2015. We conducted propensity-score-matching analyses to compare the outcomes, including postoperative complications and 30- and 90-day mortality after pancreatoduodenectomy between patients with and without hemodialysis.

Results: Of 30,495 eligible patients, 307 (1.0%) received hemodialysis. In the unmatched cohort, the proportions of male sex, younger age, pancreatic cancer, ischemic heart disease, diabetes mellitus, and hypertension were greater in patients with hemodialysis than those without hemodialysis. A 1-to-4 propensity score matching created a total of 1,535 patients, including 307 with hemodialysis and 1,228 without hemodialysis. Patients undergoing hemodialysis had greater proportions of postoperative complications, including peritonitis (8.8% vs 4.8%, P = .012), sepsis or disseminated intravascular coagulation (3.6% vs 0.7%, P = .001), intra-abdominal bleeding (4.9% vs 0.7%, P < .001), and acute coronary event (4.2% vs 1.7%, P = .015). Propensity score matching showed that patients undergoing hemodialysis had an increased risk of postoperative complications (OR, 1.62; 95% CI, 1.23-2.14; P = .001), 30-day mortality (OR, 7.45; 95% CI, 3.26-17.0; P < .001), and 90-day mortality (OR, 10.9; 95% CI, 6.58-18.2; P < .001) than those not undergoing hemodialysis.

Conclusion: Patients undergoing hemodialysis had a significantly increased risk of postoperative complications and death after pancreatoduodenectomy. In particular, surgeons should consider the increased risk of intra-abdominal bleeding, peritonitis, sepsis or disseminated intravascular coagulation, and acute coronary event in patients with hemodialysis.

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Source
http://dx.doi.org/10.1016/j.surg.2018.10.009DOI Listing
April 2019
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