Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy.
Publication/Presentation Date
8-1-2023
Abstract
BACKGROUND: While complication rates after pancreaticoduodenectomy (PD) have improved in recent decades, surgical-related death remains a possibility. Postoperative vital signs offer an untapped opportunity to identify predictors of 90-day mortality.
METHODS: We performed a retrospective chart review interrogating postoperative day (POD 0-7) vital sign measurements from patients undergoing a PD at Thomas Jefferson University Hospital, Philadelphia, PA (2009-2014). Five specific vital signs were examined as predictors of mortality: temperature, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure. Statistical analyses and logic algorithms were employed to rank vital sign parameters, with cut-points, to identify those associated with the highest risk of mortality and the most clinical relevance.
RESULTS: In our cohort, 11/750 patients (1.5%) died within 30 days of surgery, and 21/750 patients (2.8%) died within 90 days of surgery. Vital sign perturbations associated with the highest risk of mortality included mean SBP < 95 mmHg on POD 7 (odds ratio 51.46) and the mean temperature < 96.9℉ on POD 3 (odds ratio 22.63) with specificities exceeding 99%. The most clinically relevant predictor (i.e., a higher sensitivity) was DBP < 60.5 mmHg on POD 7 (odds ratio 12.45, sensitivity of 75%). These predictors remained statistically significant in a multivariable model.
CONCLUSIONS: Vital signs can be more effectively utilized to predict 90-day mortality after pancreaticoduodenectomy. Values beyond an informative threshold can potentially identify patients for more intensive monitoring with a goal of rescuing patients and preventing death.
Volume
27
Issue
8
First Page
1660
Last Page
1667
ISSN
1873-4626
Published In/Presented At
Nerwal, T., Qoshe, L., Iyer, S., Medina, G., Felix, A., Lavu, H., Yeo, C. J., & Winter, J. M. (2023). Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 27(8), 1660–1667. https://doi.org/10.1007/s11605-022-05410-0
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
37106207
Department(s)
Administration and Leadership
Document Type
Article