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Oxygen Saturation Predicts Pancreatic Leak Following Pancreatectomy: a Feasibility Study on Direct Data Transfer From the Electronic Health Record for Clinical Outcomes Research
Erin W. Gilbert*, Brian S. Diggs, Brett C. Sheppard
Department of Surgery, Oregon Health & Science University, Portland, OR
Background: As medical centers have adopted the electronic health record (EHR), automated data collection is possible and may offer the ability to analyze clinical data that has not been previously practical. A database was created via direct data transfer (DDT) from the EHR to examine the ability of perioperative vital signs, laboratory values and operative details to predict pancreatic leak following pancreatectomy.
Methods: Patients undergoing pancreatic resection from April 2008-June 2010 were identified by CPT code in a single center's EHR. Demographics, vital signs, laboratory values and operative details were collected in automated fashion via DDT. The primary endpoint, pancreatic leak, was defined as drain amylase greater than three times the upper limit of normal serum amylase. The mean of vital signs taken during the first 24 hours following surgery was calculated for analysis. Independent risk factors influencing pancreatic leak were determined by multivariable logistic regression analysis.
Results: 140 patients were identified who underwent distal pancreatectomy (31%) or pancreaticoduodenectomy (69%). The majority were for cancer (84%). The overall pancreatic leak rate was 25%. After controlling for age, mean perioperative blood pressure, blood loss, operative time, pre-operative albumin and malignancy, only oxygen saturation was found to be a significant risk factor for pancreatic leak with an odds ratio of 1.53 (CI: 1.08-2.21) for every percentage point decrease in oxygen saturation (p=0.02).
Conclusions: Automated data collection directly from the EHR is feasible and provides an opportunity to assess clinical data in ways not previously practical. Perioperative mean oxygen saturation is predictive of pancreatic leak following pancreatic resection.
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