Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

Introduction: PD is a surgical procedure with a high morbidity rate. Morbidity stems from pancreatic fistula, abscesses, and other cardiopulmonary and infectious complications. Factors associated with this increased morbidity in patients undergoing PD include preoperative albumin as well as postoperative amylase levels. Previous work has shown hypoalbuminemia on POD 1 to be contributory to post-esophagectomy complications. We set out to determine the impact of BUN and albumin on POD 1 for patients undergoing PD.Methods: We examined our prospective, IRB-approved database of 447 consecutive patients who underwent PD at TJUH between January 1, 2000 and December 31, 2008. Collected data included serum albumin pre-operatively and on POD 1. We also examined pre-operative and POD 1 BUN and hemoglobin. Morbidity was graded from I to V based on the previously published scale of Clavien et al. Grade III and above were considered serious. We examined the incidence of complications based on POD1 albumin <2.5 mg/dl versus ≥2.5 mg/dl as well as BUN<10 vs. ≥10. Student’s t-test was used to evaluate differences in length of stay (LOS). Pearson’s chi-square test and logistic regression were used to evaluate the relationship between morbidity and potential predictors. Results: Data on all variables were available in 362 patients. The median LOS in patients with albumin <2.5 was significantly increased compared to those ≥2.5 (geometric mean 10.1 vs. 7.9 days, p<0.001) and in those with BUN<10 compared to those ≥10 (7.7 vs. 9 days, p=0.003). Patients with a BUN <10 had a significantly decreased risk of any complication (38% vs. 56%, p<0.001), serious complication (9% vs. 23%, p<0.001), and pancreatic fistula (6% vs. 14%, p=0.011). Patients with POD 1 hypoalbuminemia had a significant increased risk of any complication (57% vs. 44%, p=0.033), and an increased risk of serious complication (25% vs. 14%, p=0.012), and pancreatic fistula (15% vs. 9%, p=0.095). On multivariate analysis, BUN≥10 was the most significant predictor of grade III or above complication (p=0.0019, HR=2.7) and pancreatic fistula (p=0.016, HR=2.6). POD 1 albumin <2.5 mg/dl was also an independent predictor of serious complication (p=0.01, HR=2.3). Patients with both risk factors had a 31% chance of developing serious complications and 18.5% risk of developing pancreatic fistula, while those patients with neither risk factor had a 6.5% and 3.6% risk, respectively.Conclusion: Serum albumin and BUN on POD 1 are important predictors of perioperative morbidity. These low-cost and easily accessible tests can be used as a prognostic tool to predict adverse surgical outcomes.