MORTALITY AND MORBIDITY AFTER PANCREATODUODENECTOMY IN PATIENTS UNDERGOING HEMODIALYSIS: ANALYSIS USING A NATIONAL INPATIENT DATABASE
Hiroji Shinkawa*1, Hideo Yasunaga2, Kiyoshi Hasegawa1, Hiroki Matsui2, Nobuaki Michihata2, Kiyohide Fushimi3, Norihiro Kokudo4
1Hepatobiliary-Pancreatic Surgery Division,Department of Surgery, University of Tokyo, Tokyo, Japan; 2Clinical Epidemiology and Health Economics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; 3Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan; 4National Center for Global Health and Medicine, Tokyo, Japan
Background: Whether patients undergoing hemodialysis (HD) have higher risks of mortality and morbidity after pancreatoduodenectomy remains unknown.
Methods: We used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify patients who underwent pancreatoduodenectomy from July 2010 to March 2015. We conducted propensity score-matching analyses (PSM) to compare the outcomes including postoperative complications and 30- and 90-day mortality after pancreatoduodenectomy between patients with and without HD.
Results: Of 30,495 eligible patients, 307 (1.0%) received HD. In the unmatched cohort, the proportions of male sex, younger age, pancreatic cancer, ischemic heart disease, diabetes mellitus, and hypertension were higher in patients with than without HD. One-to-four PSM created a total of 1,535 patients, including 307 with HD and 1,228 without HD. Patients undergoing HD had significantly higher proportions of postoperative complications, including peritonitis (8.8% vs. 4.8%, P=0.012), sepsis or disseminated intravascular coagulation (DIC) (3.6% vs. 0.73%, P=0.001), intra-abdominal bleeding (4.9% vs. 0.73%, P<0.001) and acute coronary event (4.2% vs. 1.7%, P=0.015). PSM showed that patients undergoing HD had significantly increased risks of postoperative complications (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.23-2.14; P=0.001), 30-day mortality (OR, 7.45; 95% CI, 3.26-17.0; P<0.001), and 90-day mortality (OR, 10.9; 95% CI, 6.58-18.2; P<0.001) than those not undergoing HD.
Conclusions: Patients undergoing HD had significantly elevated risks of postoperative complications and death after pancreatoduodenectomy. In particular, surgeons should consider the increased risk of intra-abdominal bleeding, peritonitis, sepsis or DIC, and acute coronary event in patients with HD.
Postoperative complications in patients with and without HD in the unmatched and propensity score-matched cohorts
| unmatched cohort | propensity score-matched cohort | ||||||
| Patients without HD (n = 30,188) (%) | Patients with HD (n = 307) (%) | P | Patients without HD (n =1,228) (%) | Patients with HD (n = 307) (%) | P | ||
| Pneumonia | 322 (1.1) | 7 (2.3) | 0.05 | 17 (1.4) | 7 (2.3) | 0.30 | |
| Peritonitis | 1,183 (3.9) | 27 (8.8) | <0.001 | 59 (4.8) | 27 (8.8) | 0.012 | |
| Sepsis or DIC | 330 (1.1) | 11 (3.6) | 0.001 | 9 (0.73) | 11 (3.6) | 0.001 | |
| Stroke | 110 (0.36) | 2 (0.65) | 0.31 | 5 (0.41) | 2 (0.65) | 0.63 | |
| Acute coronary event | 488 (1.6) | 13 (4.2) | 0.002 | 21 (1.7) | 13 (4.2) | 0.015 | |
| Abdominal bleeding | 297 (1.0) | 15(4.9) | <0.001 | 9(0.73) | 15(4.9) | <0.001 | |
| Bile leakage | 115 (0.38) | 1(0.33) | >0.99 | 0(0) | 1(0.33) | 0.20 | |
| Pancreatic fistula | 3,253 (10.8) | 33(10.8) | >0.99 | 169(13.8) | 33(10.8) | 0.19 | |
| At least 1 complication | 5,547 (18.4) | 94(30.6) | <0.001 | 263(21.4) | 94(30.6) | 0.001 | |
| 30-day mortality | 245 (0.81) | 16(5.2) | <0.001 | 9(0.73) | 16(5.2) | <0.001 | |
| 90-day mortality | 668 (2.2) | 53(17.3) | <0.001 | 23 (1.9) | 53(17.3) | <0.001 | |
HD, hemodialysis; DIC, disseminated intravascular coagulation
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