Background: High volume centers have lower morbidity and mortality after pancreaticoduodenectomy. Less is known about treatment pathways and their influence on ICU utilization. Our aims were to determine the prevalence of ICU utilization among patients undergoing pancreaticoduodenectomy (PD), to assess the influence of ICU admission on outcome in patients after PD and to determine what pre- and peri-operative factors are associated with ICU admission after PD.
Methods: Patients who underwent pancreaticoduodenectomy at a tertiary center during the five-year period between 1/1998 and 12/2003 were identified from a prospective database and analyzed for pre- and intraoperative factors relating to ICU admission and outcome. Results: Five hundred ninety one pancreaticoduodenectomies were performed during the study period. Five hundred thirty six patients had complete follow up. Ten percent (51/536) of patients were admitted to the ICU postoperatively. Admission to the ICU was associated with decreased disease specific and overall survival (p<.0001). Patients who had a postoperative complication including pancreatic and biliary anastomotic leak or fistula were more likely to be admitted to the ICU (p=.01). Of the preoperative predictors of ICU admission, age, blood glucose, diagnosis of DM and COPD were not predictive of ICU admission on univariate analysis. Serum creatinine, albumin and preoperative body mass index (BMI) were associated with ICU admission (p=.02, .05 and .002, respectively). Of the intraoperative factors, operative time and intraoperative blood loss correlated with ICU admission (p=.003 and .0001). On multivariate analysis of the preoperative and intraoperative factors, only preoperative BMI and EBL were independent predictors of ICU admission (p=.025 and .003). Patients with a preoperative BMI >30 had a substantially higher risk of ICU admission (RR 2.4). Conclusions: The majority of patients who undergo pancreaticoduodenectomy do not require admission to the ICU. Factors most associated with ICU admission after pancreaticoduodenectomy are increased preoperative BMI and intraoperative blood loss.
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