THE USE OF AXIAL IMAGING IN THE EARLY POSTOPERATIVE PERIOD FOLLOWING PANCREATECTOMY: IS IT EVER "TOO EARLY�?
Grace C. Bloomfield*1, Aradhya Nigam2, Pejman Radkani2, Byoung Uk Park3, Jason Hawksworth2, Thomas Fishbein2, Emily Winslow2
1Medical Student, Georgetown University School of Medicine, Washington, ; 2MedStar Georgetown University Hospital, Washington, ; 3Stanford University School of Medicine, Stanford, CA
Introduction:
Failure-to-rescue remains central to reducing mortality following pancreatic resection. Postoperative CT imaging has been shown to play an important role in intercepting failure-to-rescue precursors, though the timing of such imaging remains relatively understudied. We sought to examine the utility of immediate, early, and delayed pre-discharge abdominal CTs in pancreatectomy patients.
Methods:
Patients who underwent pancreatic resection at our institution from 2017-2022 were reviewed retrospectively. Clinical data and outcomes were recorded until 90 days postoperatively. Management before and after CT was analyzed for treatment changes and correlated with imaging findings. Patients were subdivided by the postoperative day that the first CT scan was obtained: immediate (POD<3), early (POD 3-7), and delayed (POD>7). Fisher exact/Chi-square, Student's t, and rank sum tests were used with pairwise comparisons for the early and delayed groups.
Results:
Of 370 patients, 110 (30%) had a CT during the initial surgical stay. Indications included suspicion of infection in 60 (55%), bleeding in 10 (9%), and other concerns, such as severe pain or GI symptoms, in 40 (36%). A change in treatment was observed in 59% following CT, with 15% undergoing invasive interventions and 27% treated medically. Of those who had CT imaging, 12% had scans within 3 days (immediate), 54% days 3-7 (early), and 34% after day 7 (delayed). The three groups were similar in baseline characteristics such as age, comorbidities, pathology, operative time, and number of scans (table 1). Regarding imaging indications, concerns for bleeding (15%) were more common in the immediate period while infectious suspicions predominated the early (55%) and delayed (65%) groups. The proportion of patients undergoing pancreaticoduodenectomy increased with POD group (p=0.026). Comparing the early to the delayed group (table 2), antibiotic use and initiation day (80% vs 70%, POD 5.05 vs 6.15), percutaneous drainage and placement day (12% vs 14%, POD 12.9 vs 14.6), and overall invasive interventions during surgical stay (20% vs 30%) were all similar (p=NS). Both 30 and 90-day readmission rates were equivalent as well at 18% vs 15% and 32% vs 30%, respectively (p=NS). Importantly, those scanned in the early period had significantly shorter length of stay (17.05 vs 22.82, p=0.0008) and fewer composite days hospitalized (20.10 vs 24.93, p=0.0109) relative to the delayed group. Further, surgical stay mortality rates were significantly lower in the early versus delayed group (0% vs 11%, p=0.0191).
Conclusion:
In our cohort, patients imaged early after pancreatectomy experienced shorter hospital stays and lower inpatient mortality relative to those scanned after the first postoperative week. When intra-abdominal complications are suspected following pancreatectomy, axial imaging should not be delayed.
TABLE 1: Descriptive Data of Patients Undergoing CT After Pancreatectomy Grouped by Timing of First Postoperative Scan
TABLE 2: Pairwise comparison of Interventions & Outcomes in the Early vs. Delayed CT Groups
Back to 2023 Abstracts