Synergistic Effects of Perioperative Complications on 30-Day Mortality Following Hepatopancreatic Surgery
Background Data on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following hepatopancreatic surgery have not been reported. The objective of the current study was to define the interaction effect of postoperative complications...
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Published in | Journal of gastrointestinal surgery Vol. 22; no. 10; pp. 1715 - 1723 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.10.2018
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Abstract | Background
Data on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following hepatopancreatic surgery have not been reported. The objective of the current study was to define the interaction effect of postoperative complications among patients undergoing HP surgery on 30-day mortality.
Methods
Using the ACS-NSQIP Procedure Targeted Participant Use Data File, patients who underwent HP surgery between 2014 and 2016 were identified. Hazard ratios (HRs) for 30-day mortality were estimated using Cox proportional hazard models. Two-way interaction effects assessing combinations of complications relative to 30-day mortality were calculated using the relative excess risk due to interaction (RERI) in separate adjusted Cox models.
Results
Among 26,824 patients, 10,886 (40.5%) experienced at least one complication. Mortality was higher among patients who experienced at least one complication versus patients who did not experience a complication (3.0 vs 0.1%,
p
< 0.001). The most common complications were blood transfusion (16.9%,
n
= 4519), organ space infection (12.2%,
n
= 3273), and sepsis/septic shock (8.2%,
n
= 2205). Combinations associated with additive effect on mortality included transfusion + renal dysfunction (RERI 12.3, 95% CI 5.2–19.4), pulmonary dysfunction + renal dysfunction (RERI 60.9, 95% CI 38.6–83.3), pulmonary dysfunction + cardiovascular complication (RERI 144.1, 95% CI 89.3–199.0), and sepsis/septic shock + renal dysfunction (RERI 11.5, 95% CI 4.4–18.7).
Conclusion
Both the number and specific type of complication impacted the incidence of postoperative mortality among patients undergoing HP surgery. Certain complications interacted in a synergistic manner, leading to a greater than expected increase in the risk of short-term mortality. |
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AbstractList | BACKGROUNDData on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following hepatopancreatic surgery have not been reported. The objective of the current study was to define the interaction effect of postoperative complications among patients undergoing HP surgery on 30-day mortality.METHODSUsing the ACS-NSQIP Procedure Targeted Participant Use Data File, patients who underwent HP surgery between 2014 and 2016 were identified. Hazard ratios (HRs) for 30-day mortality were estimated using Cox proportional hazard models. Two-way interaction effects assessing combinations of complications relative to 30-day mortality were calculated using the relative excess risk due to interaction (RERI) in separate adjusted Cox models.RESULTSAmong 26,824 patients, 10,886 (40.5%) experienced at least one complication. Mortality was higher among patients who experienced at least one complication versus patients who did not experience a complication (3.0 vs 0.1%, p < 0.001). The most common complications were blood transfusion (16.9%, n = 4519), organ space infection (12.2%, n = 3273), and sepsis/septic shock (8.2%, n = 2205). Combinations associated with additive effect on mortality included transfusion + renal dysfunction (RERI 12.3, 95% CI 5.2-19.4), pulmonary dysfunction + renal dysfunction (RERI 60.9, 95% CI 38.6-83.3), pulmonary dysfunction + cardiovascular complication (RERI 144.1, 95% CI 89.3-199.0), and sepsis/septic shock + renal dysfunction (RERI 11.5, 95% CI 4.4-18.7).CONCLUSIONBoth the number and specific type of complication impacted the incidence of postoperative mortality among patients undergoing HP surgery. Certain complications interacted in a synergistic manner, leading to a greater than expected increase in the risk of short-term mortality. Background Data on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following hepatopancreatic surgery have not been reported. The objective of the current study was to define the interaction effect of postoperative complications among patients undergoing HP surgery on 30-day mortality. Methods Using the ACS-NSQIP Procedure Targeted Participant Use Data File, patients who underwent HP surgery between 2014 and 2016 were identified. Hazard ratios (HRs) for 30-day mortality were estimated using Cox proportional hazard models. Two-way interaction effects assessing combinations of complications relative to 30-day mortality were calculated using the relative excess risk due to interaction (RERI) in separate adjusted Cox models. Results Among 26,824 patients, 10,886 (40.5%) experienced at least one complication. Mortality was higher among patients who experienced at least one complication versus patients who did not experience a complication (3.0 vs 0.1%, p < 0.001). The most common complications were blood transfusion (16.9%, n = 4519), organ space infection (12.2%, n = 3273), and sepsis/septic shock (8.2%, n = 2205). Combinations associated with additive effect on mortality included transfusion + renal dysfunction (RERI 12.3, 95% CI 5.2–19.4), pulmonary dysfunction + renal dysfunction (RERI 60.9, 95% CI 38.6–83.3), pulmonary dysfunction + cardiovascular complication (RERI 144.1, 95% CI 89.3–199.0), and sepsis/septic shock + renal dysfunction (RERI 11.5, 95% CI 4.4–18.7). Conclusion Both the number and specific type of complication impacted the incidence of postoperative mortality among patients undergoing HP surgery. Certain complications interacted in a synergistic manner, leading to a greater than expected increase in the risk of short-term mortality. Data on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following hepatopancreatic surgery have not been reported. The objective of the current study was to define the interaction effect of postoperative complications among patients undergoing HP surgery on 30-day mortality. Using the ACS-NSQIP Procedure Targeted Participant Use Data File, patients who underwent HP surgery between 2014 and 2016 were identified. Hazard ratios (HRs) for 30-day mortality were estimated using Cox proportional hazard models. Two-way interaction effects assessing combinations of complications relative to 30-day mortality were calculated using the relative excess risk due to interaction (RERI) in separate adjusted Cox models. Among 26,824 patients, 10,886 (40.5%) experienced at least one complication. Mortality was higher among patients who experienced at least one complication versus patients who did not experience a complication (3.0 vs 0.1%, p < 0.001). The most common complications were blood transfusion (16.9%, n = 4519), organ space infection (12.2%, n = 3273), and sepsis/septic shock (8.2%, n = 2205). Combinations associated with additive effect on mortality included transfusion + renal dysfunction (RERI 12.3, 95% CI 5.2-19.4), pulmonary dysfunction + renal dysfunction (RERI 60.9, 95% CI 38.6-83.3), pulmonary dysfunction + cardiovascular complication (RERI 144.1, 95% CI 89.3-199.0), and sepsis/septic shock + renal dysfunction (RERI 11.5, 95% CI 4.4-18.7). Both the number and specific type of complication impacted the incidence of postoperative mortality among patients undergoing HP surgery. Certain complications interacted in a synergistic manner, leading to a greater than expected increase in the risk of short-term mortality. |
Author | Pawlik, Timothy M. Bagante, Fabio Akgul, Ozgur Chen, Qinyu Idrees, Jay J. Merath, Katiuscha Cloyd, Jordan M Dillhoff, Mary |
Author_xml | – sequence: 1 givenname: Katiuscha surname: Merath fullname: Merath, Katiuscha organization: Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center – sequence: 2 givenname: Qinyu surname: Chen fullname: Chen, Qinyu organization: Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center – sequence: 3 givenname: Fabio surname: Bagante fullname: Bagante, Fabio organization: Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Department of Surgery, University of Verona – sequence: 4 givenname: Ozgur surname: Akgul fullname: Akgul, Ozgur organization: Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center – sequence: 5 givenname: Jay J. surname: Idrees fullname: Idrees, Jay J. organization: Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center – sequence: 6 givenname: Mary surname: Dillhoff fullname: Dillhoff, Mary organization: Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center – sequence: 7 givenname: Jordan M surname: Cloyd fullname: Cloyd, Jordan M organization: Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center – sequence: 8 givenname: Timothy M. orcidid: 0000-0002-4828-8096 surname: Pawlik fullname: Pawlik, Timothy M. email: tim.pawlik@osumc.edu organization: Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29916105$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1007_s11605_022_05366_1 crossref_primary_10_1016_j_hpb_2022_03_012 crossref_primary_10_1016_j_jss_2020_12_011 crossref_primary_10_1007_s11605_020_04590_x crossref_primary_10_1016_j_cmpb_2023_107439 crossref_primary_10_1016_j_surg_2021_08_030 crossref_primary_10_1186_s12913_023_10423_9 crossref_primary_10_1007_s11605_021_05088_w crossref_primary_10_1016_j_hpb_2018_12_013 crossref_primary_10_1016_j_hpb_2019_10_2446 crossref_primary_10_1007_s11605_021_05050_w crossref_primary_10_1007_s11605_021_05011_3 crossref_primary_10_1007_s11605_019_04338_2 crossref_primary_10_1097_SLA_0000000000005935 |
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Snippet | Background
Data on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following... Data on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following hepatopancreatic... BackgroundData on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following... BACKGROUNDData on the interaction effect of multiple concurrent postoperative complications relative to the risk of short-term mortality following... |
SourceID | proquest crossref pubmed springer |
SourceType | Aggregation Database Index Database Publisher |
StartPage | 1715 |
SubjectTerms | Aged Blood Transfusion - statistics & numerical data Cardiovascular Diseases - mortality Comorbidity Female Gastroenterology Gastrointestinal surgery Hepatectomy Hepatectomy - adverse effects Hepatectomy - mortality Humans Incidence Kidney Diseases - mortality Lung Diseases - mortality Male Medicine Medicine & Public Health Middle Aged Mortality Original Article Pancreatectomy - adverse effects Pancreatectomy - mortality Postoperative Complications - etiology Postoperative Complications - mortality Proportional Hazards Models Retrospective Studies Sepsis Shock, Septic - mortality Surgery |
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Title | Synergistic Effects of Perioperative Complications on 30-Day Mortality Following Hepatopancreatic Surgery |
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