Risk factors for postoperative outcomes in laparoscopic pancreaticoduodenectomy: a retrospective cohort study from 2015 to 2023.

Abstract

Background: Laparoscopic pancreaticoduodenectomy (LPD) is being increasingly performed for pancreatic tumors, offering advantages such as reduced recovery time and trauma. However, currently there is a knowledge gap in risk factors of postoperative complications, intensive care unit (ICU) admission, and prolonged hospital stays. Identifying for these outcomes is essential for improving patient management and surgical results. This retrospective cohort study aimed to explore the important risk factors for postoperative outcomes in LPD.

Methods: This retrospective cohort study included 199 patients who underwent LPD between 2015 and 2023 at a single center. Patients aged 18-85 years with pancreatic tumors were eligible, while those with distant metastases, American Society of Anesthesiologists (ASA) scores >3, or participation in other trials within 6 months prior to the current study were excluded. Data were collected on demographics, preoperative comorbidities, intraoperative variables (e.g., blood loss, transfusion, and revascularization), and postoperative outcomes, including complications, ICU admission, and length of hospital stay. The primary outcomes were postoperative complications and ICU admission, while the secondary outcomes were those factors influencing hospital stay duration. Postoperative complications, such as pancreatic fistula, biliary fistula, abdominal infection, and lung infection were documented as yes or no based on the hospital medical record system or follow-up visits. Besides, pancreatic fistula was further labeled as Grade A, B or C according to the standard of International Study Group on Pancreatic Surgery (ISGPS). The time of measurement was 90 days.

Results: The cohort consisted of 101 males (50.8%) and 98 females (49.2%), with a mean age of 60.3 years [standard deviation (SD) 9.8]. Common complications included delayed gastric emptying (8.54%), biliary fistula (5.03%), and pancreatic fistula (4.52%). At total of 58 (29.15%) patients were admitted to the ICU admission, the median length of hospital stay after surgery is 15 days. Risk factors for complications and ICU admission included a lower preoperative bilirubin level, higher intraoperative blood loss, blood transfusion, revascularization, and chronic pancreatitis. Longer hospital stays were significantly correlated with intraoperative factors such as surgery duration blood transfusion volume, and blood loss (P<0.05).

Conclusions: This study identified several key factors associated with postoperative complications and ICU admission after LPD. Blood loss, blood transfusions, and revascularization were significant predictors of longer hospital stays. Our findings highlight the importance of managing intraoperative variables, and their clinical implications include reducing complications, improving recovery, and refining patient management strategies following LPD for pancreatic tumors.