title: Incidence of and Risk Factors and Reinterventions for Post-Pancreatoduodenectomy Hemorrhage: Retrospective Analysis.
abstract: OBJECTIVE
  To analyze the incidence of and risk factors for post-pancreatoduodenectomy (PD) hemorrhage (PPH) and to evaluate the outcomes of reinterventions for PPH.
  
  
  METHODS
  All PDs between January 2009 and December 2014 were retrospectively evaluated. PPH was evaluated according to the criteria of the International Study Group of Pancreatic Surgery. Both univariate and multivariate analyses of risk factors for PPH and mortality were performed. Reinterventions were also evaluated.
  
  
  RESULTS
  Of the 1,056 PDs during the study period, 78 (7.4%) developed PPH, including 36 with grade B and 42 with grade C. Of these 78 patients, 24 (30.8%) died of PPH-related causes. Multivariate analysis showed that older age, higher total bilirubin concentration, and postoperative pancreatic fistula (POPF) were independent risk factors for PPH. Patients who died of PPH were significantly older and had lower preoperative hemoglobin and albumin concentrations than patients who did not die of PPH. Of the 78 patients with PPH, 58 underwent reintervention, including 27 who underwent angiography, 24 who underwent endoscopy, 24 who underwent re-laparotomy, and 15 who underwent more than one reintervention.
  
  
  CONCLUSIONS
  Older age, total bilirubin, and POPF are independent risk factors for PPH. Higher mortality are associated with advanced PPH and poor nutritional conditions.
authors.affiliation: Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Wang
authors.forename: Lan
authors.initials: L
authors.lastname: Fu
authors.forename: Shah Ram
authors.initials: SR
authors.lastname: Babu
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Cui-Ping
authors.initials: CP
authors.lastname: Liang
authors.forename: Bo-Le
authors.initials: BL
authors.lastname: Tian
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016577:Pancreaticoduodenectomy; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Morbidity; Pancreatoduodenectomy; Postoperative hemorrhage; Reintervention; Risk factors