title: Serum blood urea nitrogen and serum albumin on the first postoperative day predict pancreatic fistula and major complications after pancreaticoduodenectomy.
abstract: BACKGROUND
  Pancreaticoduodenectomy (PD) has a high morbidity rate. Previous work has shown that hypoalbuminemia on postoperative day 1 (POD) to be contributory to post-esophagectomy complications. We set out to determine the impact of blood urea nitrogen (BUN) and albumin on POD 1 for patients undergoing PD.
  
  
  METHODS
  We examined 446 consecutive patients who underwent PD at the Thomas Jefferson University Hospital between January 1, 2000 and December 31, 2008. Complications were graded using the Clavien scale. We examined the incidence of complications based on POD 1 albumin <2.5 versus ≥2.5 mg/dl, as well as POD 1 BUN <10 vs. ≥10 g/dL.
  
  
  RESULTS
  Patients with a BUN <10 had a significantly decreased risk of any complication (p < 0.001), serious complication (p < 0.001), and pancreatic fistula (p = 0.011). On multivariate analysis, BUN ≥ 10 was the most significant predictor of grade III or above complication (p = 0.0019, hazard ration (HR) = 2.7) and pancreatic fistula (p = 0.016, HR = 2.6). POD 1 albumin <2.5 mg/dl was also an independent predictor of serious complication (p = 0.01, HR = 2.3). Patients with both risk factors had a 31 % chance of developing serious complications and 18.5 % risk of developing pancreatic fistula, while those patients with neither risk factor had a 6.5 and 3.6 % risk, respectively.
  
  
  CONCLUSIONS
  Serum albumin and BUN on POD 1 are important predictors of perioperative morbidity following PD. These low-cost and easily accessible tests can be used as a prognostic tool to predict adverse surgical outcomes.
authors.affiliation: Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Relles
authors.forename: Nathan G
authors.initials: NG
authors.lastname: Richards
authors.forename: Jordan P
authors.initials: JP
authors.lastname: Bloom
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Kennedy
authors.forename: Patricia K
authors.initials: PK
authors.lastname: Sauter
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Leiby
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Adam C
authors.initials: AC
authors.lastname: Berger
mesh_terms: D001806:Blood Urea Nitrogen; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000097:blood* / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D013997:Time Factors
chemical_list: D012709:Serum Albumin