title: Unplanned reoperation and reintervention after pancreatic resections: an analysis of risk factors.
abstract: BACKGROUND
  The purpose of the study was to determine the incidence of any unplanned reoperation or reintervention procedure after pancreatic resection and to identify the underlying risk factors.
  
  
  METHODS
  A total of 189 consecutive pancreatic resections performed from 2001-2008 were searched for any unplanned reoperation, percutaneous drainage, or angiographic reintervention. A retrospective analysis of a prospectively maintained database, including patient characteristics, comorbidities, details of surgery, specific complications, incidence of reoperation/reintervention, and mortality was performed.
  
  
  RESULTS
  Overall rates of reoperation, reintervention, and mortality were 6.3% (12/189), 7.9% (15/189), and 1.6% (3/189), respectively. Four patients underwent reintervention and reoperation, so the combined reoperation/reintervention rate was 12.2% (23/189). Reoperation (P < 0.001) and reintervention (P = 0.002) correlated with mortality. Hemorrhage (relative risk [RR], 58; P = 0.0017) and the combination of hemorrhage and pancreatic fistula (RR, 117; P < 0.0001) were identified as risk factors for unplanned reoperation, hemorrhage (RR, 82; P = 0.005), pancreatic fistula (RR, 42; P < 0.001), and the combination of both complications (RR, 246; P < 0.001) for reoperation and/or reintervention. Other patient- or procedure-related factors did not influence the reoperation and/or reintervention rates significantly.
  
  
  CONCLUSIONS
  Pancreatic fistula and hemorrhage are the predominant factors that afford unplanned reoperation/reintervention. Although reporting the incidence of unplanned reoperation will include the most severe postoperative complications, a considerable number of reinterventions are missed. Therefore, in outcome analyses of pancreatic surgery, not only reoperations but also any interventional therapies should be included.
authors.affiliation: Department of Surgery, Krankenhaus der Elisabethinen, Academic Teaching Hospital of the Medical Universities of Graz, Innsbruck and Vienna, Fadingerstrasse 1, 4020 Linz, Austria. odogangl@yahoo.com
authors.forename: Odo
authors.initials: O
authors.lastname: Gangl
authors.forename: Uwe
authors.initials: U
authors.lastname: Fröschl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hofer
authors.forename: Jürgen
authors.initials: J
authors.lastname: Huber
authors.forename: Thomas
authors.initials: T
authors.lastname: Sautner
authors.forename: Reinhold
authors.initials: R
authors.lastname: Függer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors