title: Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy: an NSQIP propensity-score matched analysis.
abstract: BACKGROUND
  Select patients with peri-ampullary cancers require concomitant colon resection (CR) during a pancreaticoduodenectomy (PD) for margin-negative resections. This study analysed the impact of concomitant CR on major morbidity (MM) and mortality.
  
  
  METHODS
  National Surgical Quality Improvement Program (NSQIP) patients undergoing PD for peri-ampullary cancers were identified from 2005 to 2012. A 4 : 1 propensity-score matched analysis isolated the impact of CR upon PD. Risk factors for 30-day MM and mortality were analysed to determine post-operative sequelae of PD+CR.
  
  
  RESULTS
  From 10 965 PD and 159 PD+CR patients, 624 and 156, respectively, were selected for 4 : 1 matched analysis. PD+CR resulted in a higher MM and mortality (50.0% and 9.0%) versus PD alone (28.8% and 2.9%, respectively, P < 0.001). Multivariate analysis identified risk factors for MM after PD: concomitant CR [odds ratio (OR)-3.19, P < 0.001], smoking (OR-1.92, P = 0.005), a lack of functional independence (OR-3.29, P = 0.018), cardiac disease (OR-2.39, P = 0.011), decreased albumin (per g/dl, OR-1.38, P = 0.033) and a longer operative time (versus median time, OR-1.56, P = 0.029). Independent predictors of mortality included concomitant CR (OR-3.16, P = 0.010), ventilator dependence (OR-13.87, P < 0.001) and septic shock (OR-6.02, P < 0.001).
  
  
  CONCLUSIONS
  CR was an independent predictor of MM and mortality after a PD. Patients requiring PD+CR should be identified pre-operatively, maximally optimized and referred to experienced surgeons at expert centres.
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA.
authors.forename: Jennifer W
authors.identifier: http://orcid.org/0000-0001-8882-4765
authors.initials: JW
authors.lastname: Harris
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA.
authors.forename: Jeremiah T
authors.initials: JT
authors.lastname: Martin
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA.
authors.forename: Erin C
authors.initials: EC
authors.lastname: Maynard
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: McGrath
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA.
authors.forename: Ching-Wei D
authors.initials: CW
authors.lastname: Tzeng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D004379:Duodenal Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D058996:Quality Improvement; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult