Peri-operative blood transfusion and operative time are quality indicators for pancreatoduodenectomy.
BACKGROUND
Minimization of blood loss during pancreatoduodenectomy requires careful surgical technique and specific preventative measures. Therefore, red blood cell (RBC) transfusions and operative time are potential surgical quality indicators. The aim of the present study was to compare peri-operative RBC transfusion and operative time with 30-day morbidity/mortality after pancreatoduodenectomy.


METHODS
All pancreatoduodenectomies (2005 to 2008) were identified using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). RBC transfusions and operative time were correlated with 30-day morbidity/mortality.


RESULTS
Pancreatoduodenectomy was completed in 4817 patients. RBC transfusions were given to 1559 (32%) patients (1-35 units). Overall morbidity and mortality rates were 37% and 3.0%, respectively. Overall 30-day morbidity increased in a stepwise manner with the number of RBC transfusions (R = 0.69, P < 0.01). Although RBC transfusions and operative times were not statistically linked (P = 0.87), longer operative times were linearly associated with increased 30-day morbidity (R = 0.79, P < 0.001) and mortality (R = 0.65, P < 0.01). Patients who were not transfused also displayed less morbidity (33%) and mortality (1.9%) (P < 0.05).


CONCLUSIONS
Peri-operative RBC transfusion after pancreatoduodenectomy is linearly associated with 30-day morbidity. Longer operative time also correlates with increased morbidity and mortality. Therefore, blood transfusions and prolonged operative time should be considered quality indicators for pancreatoduodenectomy.
Ball
Chad G
CG
Departments of Surgery, Indiana University, Indianapolis, IN, USA.
Pitt
Henry A
HA
Kilbane
Molly E
ME
Dixon
Elijah
E
Sutherland
Francis R
FR
Lillemoe
Keith D
KD
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017707:Erythrocyte Transfusion; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D019990:Perioperative Care; D019984:Quality Indicators, Health Care; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States
HPB (Oxford). 2010 Feb;12(1):50-5
20495645
Adv Surg. 2008;42:33-48
18953808
Surg Gynecol Obstet. 1970 Jun;130(6):1049-53
4192028
HPB (Oxford). 2009 Aug;11(5):405-13
19768145
Arch Surg. 2003 Mar;138(3):314-24
12611581
Arch Surg. 1973 Aug;107(2):206-10
4719566
Arch Surg. 2007 Apr;142(4):371-80
17438173
Br J Surg. 1995 May;82(5):582-7
7613921
Ann Surg. 1982 Mar;195(3):274-81
6277259
Crit Care Med. 2003 Dec;31(12 Suppl):S678-86
14724466
HPB (Oxford). 2007;9(5):330-4
18345314
J Am Coll Surg. 2010 Jan;210(1):60-5.e1-2
20123333
Ann Surg. 1998 Oct;228(4):491-507
9790339
J Am Coll Surg. 1995 May;180(5):519-31
7749526
J Am Coll Surg. 2008 Nov;207(5):777-82
18954793
J Surg Res. 2007 Jul;141(1):97-104
17574043
Br J Surg. 1998 Feb;85(2):171-8
9501809
Clin Oncol (R Coll Radiol). 2006 Feb;18(1):60-6
16477921
J Am Coll Surg. 1997 Oct;185(4):315-27
9328380
Ann Surg. 1994 Dec;220(6):791-7
7986147
Gynecol Oncol. 2005 May;97(2):446-56
15863144
Arch Surg. 1993 Feb;128(2):171-6; discussion 176-7
8431117
J Am Coll Surg. 2007 Jun;204(6):1103-14
17544069
Ann Surg. 1993 May;217(5):430-5; discussion 435-8
8098202
J Surg Oncol. 2009 Jun 15;99(8):508-12
19466741
J Trauma. 2003 May;54(5):908-14
12777903
Surgery. 1989 Nov;106(5):836-41
2683172
Surg Gynecol Obstet. 1989 Sep;169(3):219-22
2672385
J Gastrointest Surg. 2004 Dec;8(8):951-9
15585382
Ann Surg. 1998 Sep;228(3):429-38
9742926
Ann Surg. 1941 Oct;114(4):612-5
17857897
HPB (Oxford). 2002;4(1):5-10
18333146
Surgery. 2005 Feb;137(2):148-55
15674194
J Am Coll Surg. 1997 Oct;185(4):328-40
9328381
Surgery. 2005 Nov;138(5):837-43
16291383
Ann Surg. 1997 Sep;226(3):248-57; discussion 257-60
9339931
J Gastrointest Surg. 2006 Dec;10(10):1338-45; discussion 1345-6
17175452
J Am Coll Surg. 2007 Jun;204(6):1089-102
17544068
Am J Surg. 1997 Apr;173(4):275-9
9136779
Ann Surg. 2003 Jun;237(6):860-9; discussion 869-70
12796583
Br J Surg. 2007 Jul;94(7):860-5
17380562
N Engl J Med. 1999 Feb 11;340(6):409-17
9971864
J Am Coll Surg. 2009 Dec;209(6):712-9
19959039
Ann Surg. 2002 Sep;236(3):344-53; discussion 353-4
12192321