title: Computed tomography attenuation and patient characteristics as predictors of complications after pancreaticoduodenectomy.
abstract: OBJECTIVE
  Morbidity after pancreaticoduodenectomy (PD) remains high. Computed tomography (CT) of intra-abdominal tissue has not been thoroughly evaluated to establish associations with the occurrence of complications after PD. The current study sought to determine whether differences in non-enhanced visceral attenuation predicted complications after PD.
  
  
  METHODS
  Outcomes in patients undergoing PD were analysed according to the Clavien system for classifying complications and the International Study Group on Pancreatic Fistula system for classifying postoperative pancreatic fistula (POPF). Preoperative non-enhanced CT scans were evaluated by a blinded investigator for attenuation of abdominal viscera and fat thickness. Data on pancreatic firmness and pancreatic duct size were collected. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  A total of 134 patients underwent PD for malignant and benign disease. Rates of morbidity, mortality and POPF at 90 days were 61%, 4% and 23%, respectively. Patients with a body mass index of > 25 kg/m(2) had higher rates of POPF (P = 0.05) and complications (P < 0.01). In multivariate analysis, patients were more likely to develop any complication as CT attenuation decreased for paraspinus muscle (P < 0.01), spleen (P < 0.03) and liver (P = 0.01) parenchyma.
  
  
  CONCLUSIONS
  Postoperative complications after PD remain prevalent. Decreased CT attenuation of abdominal viscera is an independent predictor of morbidity after PD and suggests a high-risk patient physiology for pancreatic resection.
authors: Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0016, USA.
authors: John C
authors: JC
authors: McAuliffe
authors: Karen
authors: K
authors: Parks
authors: Prakash
authors: P
authors: Kumar
authors: Sandre F
authors: SF
authors: McNeal
authors: Desiree E
authors: DE
authors: Morgan
authors: John D
authors: JD
authors: Christein
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D010185:Pancreatic Fistula / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014781:Viscera / Q000000981:diagnostic imaging*