Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2019; 7(1): 28-38
Published online Jan 6, 2019. doi: 10.12998/wjcc.v7.i1.28
Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy
Narongsak Rungsakulkij, Pongsatorn Tangtawee, Wikran Suragul, Paramin Muangkaew, Somkit Mingphruedhi, Suraida Aeesoa
Narongsak Rungsakulkij, Pongsatorn Tangtawee, Wikran Suragul, Paramin Muangkaew, Somkit Mingphruedhi, Suraida Aeesoa, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Rungsakulkij N designed the study, collected and interpreted the data, and wrote the paper; Tangtawee P collected and analyzed the data; Suragul W collected the data; Mingphruedhi S collected the data; Muangkaew P collected the data; and Aeesoa S collected and analyzed the data.
Institutional review board statement: This study was reviewed and approved by the Ramathibodi Hospital Institutional Review Board Committee on Human Rights Related to Research Involving Human Subjects (protocol number ID 07-61-25).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Narongsak Rungsakulkij, FRCS (Gen Surg), MD, Doctor, Lecturer, Surgeon, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Praram VI Road, Ratchathewi, Bangkok 10400, Thailand. narongsak.run@mahidol.ac.th
Telephone: +66-2-2011527 Fax: +66-2-2012471
Received: September 6, 2018
Peer-review started: September 6, 2018
First decision: October 19, 2018
Revised: October 26, 2018
Accepted: December 21, 2018
Article in press: December 21, 2018
Published online: January 6, 2019
Abstract
BACKGROUND

Pancreaticoduodenectomy (PD) is a complex surgical procedure with a high morbidity rate. The serious complications are major risk factors for poor long-term surgical outcome. Studies have reported an association between early postoperative prognostic nutritional index (PNI) and prediction of severe complications after abdominal surgery. However, there have been no studies on the use of early postoperative PNI for predicting serious complications following PD.

AIM

To analyze the risk factors and early postoperative PNI for predicting severe complications following PD.

METHODS

We retrospectively analyzed 238 patients who underwent PD at our hospital between January 2007 and December 2017. The postoperative complications were classified according to the Dindo-Clavien classification. Grade III-V postoperative complications were classified as serious. The risk factors for serious complications were analyzed by univariate analysis and multivariate logistic regression analysis.

RESULTS

Overall complications were detected in 157 of 238 patients (65.9%) who underwent PD. The grade III-V complication rate was 26.47% (63/238 patients). The mortality rate was 3.7% (9/238 patients). Multivariate logistic regression analysis revealed that preoperative serum albumin [odds ratio (OR): 0.883, 95% confidence interval (CI): 0.80-0.96; P < 0.01] and PNI on postoperative day 3 < 40.5 (OR: 2.77, 95%CI: 1.21-6.38, P < 0.05) were independent factors associated with grade III-V postoperative complications.

CONCLUSION

Perioperative albumin is an important factor associated with serious complications following PD. Low early postoperative PNI (< 40.5) is a predictor for serious complications.

Keywords: Postoperative complications, Pancreatectomy, Serum albumin, Risk factors, Prognostic nutritional index

Core tip: Pancreaticoduodenectomy (PD) is a complex surgical procedure with a high morbidity rate. The serious complications are major risk factors for poor long-term surgical outcome. Studies have reported an association between early postoperative prognostic nutritional index (PNI) and prediction of severe complications after abdominal surgery. However, there have been no studies on the use of early postoperative PNI for predicting serious complications following PD. We retrospectively analyzed 238 patients who underwent PD at our hospital. The independent factors associated with serious postoperative complications following PD were preoperative serum albumin and PNI on postoperative day 3 of < 40.5. Thus, patients who undergo PD and have early postoperative low PNI should be monitored closely.