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2007 Program and Abstracts | 2007 Posters
Clinical Impact of the Reoperative Abdomen in Resective Pancreatic Surgery
Wande Pratt*, Shishir K. Maithel, Mark P. Callery, Charles M. Vollmer
Department of Surgery, Beth Israel Deaconess Med Center, Boston, MA

Background: Today, reoperative abdominal surgery is performed with increasing frequency, particularly for high-acuity surgical conditions. Although some believe that prior abdominal operations further complicate surgical care, this concept has not been scrutinized for either major abdominal operations or, more specifically, pancreatic resections.
Methods: 308 consecutive pancreatic resections (218 pancreatoduodenectomies; 90 distal pancreatectomies) were performed between 10/01 and 10/06. Patients were stratified according to the number of prior abdominal operations. Clinical and economic outcomes were analyzed and compared between the groups.
Results: Over one-half of patients presented with a previous intra-abdominal operation — 29% with one operation, 18% with two, and 6% with ≥ 3. Among this reoperative cohort, the most common open operations were prior appendectomy (31%), cholecystectomy (30%), and hysterectomy (22%)—prior laparoscopy (primarily cholecystectomy) was rare (9%). Although both median operative time and blood loss during pancreatic resection were equivalent between reoperative and non-reoperative patients, certain postoperative outcomes differed considerably (Table). Overall rates of complications were significantly higher among reoperative patients. While rates of pancreatic fistulae were similar, infectious complications (wound infections, abscesses, sepsis) were significantly higher (p = .024). This was associated with increased antibiotic administration, invasive interventions, and ICU utilization. Although these events did not prolong hospital stays, marginal increases in (median) hospital costs were observed among reoperative patients undergoing proximal (,868) and distal pancreatectomy (,227). Multiple prior operations had no additive effects.
Conclusion: Pancreatic resection is frequently performed for patients who have been subjected to previous abdominal operations. Although this operative scenario can be managed safely and efficiently, the postoperative period is often associated with significant complications that demand intensive management approaches and increase resource utilization.
Postoperative outcomes in reoperative patients undergoing pancreatic resection.

Non-Reoperative Reoperative p-value
Patients (% of all resections) 146 (47%) 162 (53%) --
Complications 66 (45%) 103 (64%) .001
Pharmacologic Intervention Blood Transfusion Total Parenteral Nutrition Antibiotics 21 (14%) 14 (10%) 35 (24%) 31 (19%) 26 (16%) 58 (36%) .289 .126 .026
Invasive Intervention Endoscopic/Percutaneous Reoperation 16 (11%) 4 (3%) 32 (20%) 11 (7%) .041 .117
ICU Utilization 4 (3%) 13 (8%) .048
Duration of Stay (median) 8 days 8 days .236
Discharge Disposition Home Home with VNA Rehabilitation Facilities 65 (59%) 32 (29%) 13 (12%) 45 (43%) 35 (33%) 25 (24%) .024
Total Hospital Costs (median) Pancreatoduodenectomy Distal Pancreatectomy $18,398 $15,555 $20,796 $16,782 .468 .316

2007 Program and Abstracts | 2007 Posters
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