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| Ventilation after pancreaticoduodenectomy increases perioperative mortality: Identification of risk factors and their relevance in Germany that do not apply in England |
| Rieke-Sophie Homeyer a , b , Keith J. Roberts c , Robert P Sutcliffe c , Alexander Kaltenborn a , Darius Mirza c , Zhi Qu a , Jürgen Klempnauer b , Harald Schrem a , b , d , ∗ |
a Core Facility Quality Management Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
b General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
c Department of HPB Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way Edgbaston, Birmingham B15 2GW, United Kingdom
d Department of General, Visceral and Transplant Surgery, Medical University Graz, Auenbrugger Platz 5, 8036 Graz, Austria
∗ Corresponding author at: Department of General, Visceral and Transplant Surgery, Medical University Graz, AustriaAuenbrugger Platz 5, 8036 Graz, Austria.
E-mail address: harald.schrem@medunigraz.at (H. Schrem).
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Abstract Background: Pre-operative risk factors for post-operative ventilation and their influence on survival after pancreaticoduodenectomy for malignancy are unknown.
Methods: Totally 391 patients operated in Hannover, Germany were investigated with multivariable lo- gistic regression and Cox regression modeling to identify independent risk factors for post-operative ventilation ≥6 h, patient survival and 90-day mortality. And 84 patients operated in Birmingham, United Kingdom were analyzed to assess the external relevance of findings.
Results: Longer operations, history of thrombosis, intra-operative blood transfusion, lower estimated glomerular filtration rates (eGFR) and higher values of the age at operation divided by the Horovitz Quotient independently increased the risk of post-operative ventilation ≥6 h in German patients ( n = 108; 27.6%) ( P < 0.050). Blood transfusion and lower pre-operative eGFR levels increased the risk of early death in German patients significantly and independently of established prognostic factors. A history of throm- bosis and lower eGFR levels were also independent significant risk factors for 90-day mortality in German patients but not in English patients. None of the English patients received post-operative ventilation. Significantly more German patients were > 75 years, had a history of thrombosis, received blood transfusions, and had significantly worse lung function parameters. pT4 tumors were detected in 18 German patients (4.6%), but not in the English patients.
Conclusions: Identified risk factors for post-operative ventilation are clinically relevant in Germany but not in England and may be used to lower mortality risk. The German and the English cohorts displayed significant differences in the approach to patient selection and early post-operative extubation.
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2019, Vol. 18 
