title: Targeting early deaths following pancreaticoduodenectomy to improve survival.
abstract: BACKGROUND
  There is increasing focus on disease-specific outcomes. This study was undertaken to analyze early mortality after pancreaticoduodenectomy as part of a strategy to improve long-term outcome.
  
  
  METHODS
  One thousand thirty-one patients who underwent pancreaticoduodenectomy from 1992 to 2010 were studied. Median data are reported.
  
  
  RESULTS
  Fifty-eight (5.6%) patients died within 90 days after pancreaticoduodenectomy. All patients had at least one significant comorbidity, commonly cardiorespiratory in nature (76%). Sixty percent of patients had depressed serum albumin levels, and 43% were jaundiced. The American Society of Anesthesiologists class was: 17% class II, 72% class III, and 10% class IV. Seventy-four percent had malignant disease. Twenty-two percent of patients underwent a major vascular resection at the time of pancreaticoduodenectomy. Causes of death were vascular/bleeding related (26%), cardiorespiratory causes (17%), multiorgan failure (12%), leak/perforation (10%), cancer progression (9%), infection (7%), or indeterminate (19%).
  
  
  CONCLUSIONS
  Death within 90 days after pancreaticoduodenectomy is uncommon, occurs in relatively older deconditioned patients, and is generally not causally related to underlying malignancy. Early death is generally associated with vascular or bleeding complications. Strategies to minimize early death should focus on careful patient selection and prompt recognition and management of herald bleeding or vascular thrombosis, as it can often result in perioperative death following pancreaticoduodenectomy.
authors.affiliation: College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Whalen
authors.initials: W
authors.lastname: Clark
authors.forename: Melissa
authors.initials: M
authors.lastname: Silva
authors.forename: Natalie
authors.initials: N
authors.lastname: Donn
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.forename: Leigh Ann
authors.initials: LA
authors.lastname: Humphries
authors.forename: Harold
authors.initials: H
authors.lastname: Paul
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hernandez
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome