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Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy
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...
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| Published in: | Journal of gastrointestinal surgery 2023-08, Vol.27 (8), p.1660-1667 |
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| container_end_page | 1667 |
| container_issue | 8 |
| container_start_page | 1660 |
| container_title | Journal of gastrointestinal surgery |
| container_volume | 27 |
| creator | Nerwal, Teena Qoshe, Livia Iyer, Sneha Medina, Genevieve Felix, Adrian Lavu, Harish Yeo, Charles J. Winter, Jordan M. |
| description | 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 |
| doi_str_mv | 10.1007/s11605-022-05410-0 |
| format | article |
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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.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-022-05410-0</identifier><identifier>PMID: 37106207</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Blood pressure ; Gastroenterology ; Humans ; Medicine ; Medicine & Public Health ; Mortality ; Original Article ; Pancreatectomy - adverse effects ; Pancreatic cancer ; Pancreaticoduodenectomy ; Pancreaticoduodenectomy - adverse effects ; Postoperative Complications - etiology ; Postoperative period ; Retrospective Studies ; Signs ; Surgery ; Vital Signs - physiology</subject><ispartof>Journal of gastrointestinal surgery, 2023-08, Vol.27 (8), p.1660-1667</ispartof><rights>The Society for Surgery of the Alimentary Tract 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Society for Surgery of the Alimentary Tract.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-f21ea19a9d0970dbd8874b3c746696cfa1af286f0d17844316447971d19df3ba3</citedby><cites>FETCH-LOGICAL-c375t-f21ea19a9d0970dbd8874b3c746696cfa1af286f0d17844316447971d19df3ba3</cites><orcidid>0000-0002-7674-9304</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37106207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nerwal, Teena</creatorcontrib><creatorcontrib>Qoshe, Livia</creatorcontrib><creatorcontrib>Iyer, Sneha</creatorcontrib><creatorcontrib>Medina, Genevieve</creatorcontrib><creatorcontrib>Felix, Adrian</creatorcontrib><creatorcontrib>Lavu, Harish</creatorcontrib><creatorcontrib>Yeo, Charles J.</creatorcontrib><creatorcontrib>Winter, Jordan M.</creatorcontrib><title>Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>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.</description><subject>Blood pressure</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Pancreatectomy - adverse effects</subject><subject>Pancreatic cancer</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative period</subject><subject>Retrospective Studies</subject><subject>Signs</subject><subject>Surgery</subject><subject>Vital Signs - physiology</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kUuLFTEQhYMozjj6B1xIwI2baFU6ncdyGMcHjHhhVNyFdJIeeujbuSZpof-90TsquHBVBfXVqUMdQp4ivEQA9aogSugZcM6gFwgM7pFT1KpjQnJ5v_VgkPG-_3pCHpVyC4AKUD8kJ51CkBzUKXGXLs8b3aVS0yFmV6fvkX6Zqpvp9XSzFLrLMUy-0ut1KPHbGpdKDbDXbqMfUm7YVDd6PtaY6c4tPsem4FNYU4hL9DXtt8fkwejmEp_c1TPy-c3lp4t37Orj2_cX51fMd6qvbOQYHRpnAhgFYQhaKzF0XgkpjfSjQzdyLUcIqLQQHUohlFEY0ISxG1x3Rl4cdQ85NZ-l2v1UfJxnt8S0Fss1KINolGjo83_Q27TmpblrlNCAErluFD9SPqdSchztIU97lzeLYH8GYI8B2BaA_RWAhbb07E56HfYx_Fn5_fEGdEegtNFyE_Pf2_-R_QEt4pBJ</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Nerwal, Teena</creator><creator>Qoshe, Livia</creator><creator>Iyer, Sneha</creator><creator>Medina, Genevieve</creator><creator>Felix, Adrian</creator><creator>Lavu, Harish</creator><creator>Yeo, Charles J.</creator><creator>Winter, Jordan M.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7674-9304</orcidid></search><sort><creationdate>20230801</creationdate><title>Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy</title><author>Nerwal, Teena ; Qoshe, Livia ; Iyer, Sneha ; Medina, Genevieve ; Felix, Adrian ; Lavu, Harish ; Yeo, Charles J. ; Winter, Jordan M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-f21ea19a9d0970dbd8874b3c746696cfa1af286f0d17844316447971d19df3ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Blood pressure</topic><topic>Gastroenterology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Pancreatectomy - adverse effects</topic><topic>Pancreatic cancer</topic><topic>Pancreaticoduodenectomy</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative period</topic><topic>Retrospective Studies</topic><topic>Signs</topic><topic>Surgery</topic><topic>Vital Signs - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nerwal, Teena</creatorcontrib><creatorcontrib>Qoshe, Livia</creatorcontrib><creatorcontrib>Iyer, Sneha</creatorcontrib><creatorcontrib>Medina, Genevieve</creatorcontrib><creatorcontrib>Felix, Adrian</creatorcontrib><creatorcontrib>Lavu, Harish</creatorcontrib><creatorcontrib>Yeo, Charles J.</creatorcontrib><creatorcontrib>Winter, Jordan M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nerwal, Teena</au><au>Qoshe, Livia</au><au>Iyer, Sneha</au><au>Medina, Genevieve</au><au>Felix, Adrian</au><au>Lavu, Harish</au><au>Yeo, Charles J.</au><au>Winter, Jordan M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>27</volume><issue>8</issue><spage>1660</spage><epage>1667</epage><pages>1660-1667</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37106207</pmid><doi>10.1007/s11605-022-05410-0</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7674-9304</orcidid></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 2023-08, Vol.27 (8), p.1660-1667 |
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| source | Springer Nature |
| subjects | Blood pressure Gastroenterology Humans Medicine Medicine & Public Health Mortality Original Article Pancreatectomy - adverse effects Pancreatic cancer Pancreaticoduodenectomy Pancreaticoduodenectomy - adverse effects Postoperative Complications - etiology Postoperative period Retrospective Studies Signs Surgery Vital Signs - physiology |
| title | Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy |
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