Effect of overtime pancreaticoduodenectomy on the short-term prognosis of patients

Table 1 Preoperative clinical characteristic of all patients

Characteristic	Total (n = 235)
Age (median, range), yr	64 (range 14-89)
Sex, n (%)
Male	153 (65.1)
Female	82 (34.9)
Preoperative comorbidities, n (%)
Diabetes	46 (19.6)
Hypertension	98 (37.4)
Coronary heart disease	19 (8.1)
Hepatobiliary and pancreatic diseases	46 (19.6)
Location of the lesions, n (%)
Pancrea	95 (40.4)
Bile duct	81 (34.6)
Duodenum	59 (25.1)

Table 2 Patient characteristics and operative parameters

	Control group (n = 177)	Overtime group (n = 58)	P value
Age (yr)	63 (14-89)	64 (29-84)	0.987
Sex			0.694
Male	114 (64.4%)	39 (67.2%)
Female	63 (35.6%)	19 (32.8%)
BMI (kg/m2)	22.7 (14.8-36.8)	22.9 ± 2.79	0.922
ASA classification			0.227
Ι	14 (7.9%)	3 (5.2%)
ΙΙ	130 (73.4%)	49 (84.5%)
ΙΙΙ	33 (18.6%)	6 (10.3%)
History of hepatobiliary and pancreatic disease	32 (18.1%)	14 (24.1%)	0.313
Diabetes	33 (18.6%)	13 (22.4%)	0.53
Hypertension	67 (37.9%)	21 (36.2%)	0.822
Coronary artery disease	14 (7.9%)	5 (8.6%)	0.863
Cerebrovascular disease	16 (9.0%)	2 (3.4%)	0.165
Preoperative total bilirubin	85.8 (5.4-793.5)	93.8 (5.3-610.2)	0.566
Primary site			0.644
Pancreas	74 (41.8%)	21 (36.2%)
Bile duct	61 (34.5%)	20 (34.5%)
Duodenum	42 (23.7%)	17 (29.3%)
Surgeon			0.085
A	21 (11.9%)	5 (8.6%)
B	30 (16.9%)	17 (29.3%)
C	32 (18.1%)	13 (22.4%)
D	17 (9.6%)	6 (10.3%)
E	34 (19.2%)	3 (5.2%)
F	43 (24.3%)	14 (24.1%)
Technique of reconstruction			0.233
Roux-en-Y	94 (53.1%)	36 (62.1%)
Child surgery	83 (46.9%)	22 (37.9%)
Pancreaticojejunostomy technique			0.686
Duct-to-mucosa	53 (29.9%)	19 (32.8%)
Invagination	124 (70.1%)	39 (67.2%)
Operative time (min)	413 (260-796)	421.1 ± 83.4	0.757
Blood loss (mL)	600 (100-4700)	700 (150-2800)	0.185
Number of lymph nodes removed	9 (0-62)	10 (1-45)	0.994

BMI: Body mass index.

Table 3 Intraoperative and postoperative clinical characteristic of all patients

Characteristic	Total (n = 235)
Operating time (median, range), min	416 (260-796)
Blood loss volume (median, range), mL	600 (100-4700)
Number of lymph nodes removed (median, range)	10 (0-62)
ICU length of stay (median, range), h	16 (0-518)
Hospital length of stay (median, range), d	19 (7-160)
Postoperative complications, n (%)
Pancreatic fistula	47 (20.0)
Delayed gastric emptying (B/C)	39 (16.6)
Gastrointestinal bleeding	25 (10.6)
Abdominal infection	14 (3.0)
Pneumonia	6 (2.6)
Arrhythmia	6 (2.6)
Thromboembolism	2 (0.9)
Respiratory failure	1 (0.4)
Gastrointestinal bleeding	1 (0.4)
Death during hospitalization, n (%)
Gastrointestinal bleeding	2 (0.9)
Pancreatic fistula	4 (1.7)
Abdominal infection	1 (0.4)
Pneumonia	3 (1.3)

ICU: Intensive Care Unit.

Table 4 Postoperative factors and complications

	Control group (n = 177)	Overtime group (n = 58)	P value
Operative time (min)	413 (260-796)	421.1 ± 83.4	0.757
Blood loss (mL)	600 (100-4700)	700 (150-2800)	0.185
Number of lymph nodes removed	9 (0-62)	10 (1-45)	0.994
Duration of treatment in ICU after surgery	17 (0-325)	14 (0-518)	0.511
Duration of postoperative hospitalization	20 (7-160)	18 (7-61)	0.181
Postoperative pancreatic fistula	28 (15.8%)	19 (32.8%)	0.005
Delayed gastric emptying (B/C)	30 (16.9%)	9 (15.5%)	0.799
Gastrointestinal bleeding	17 (9.6%)	8 (13.8%)	0.369
Abdominal infection	12 (6.8%)	2 (3.4%)	0.352
Pneumonia	3 (1.7%)	3 (5.2%)	0.162
Arrhythmia	6 (3.4%)	0	0.341
Thromboembolism	2 (1.1%)	0	1.000
Respiratory failure	1 (0.6%)	0	1.000
Hemothorax	1 (0.6%)	0	1.000
Hospital death	7 (4.0%)	3 (5.2%)	0.690

ICU: Intensive Care Unit.

Table 5 P values, odds ratios, and selected 95%CI for pancreatic fistula from univariate logistic regression models

Parameter	P value	Odds ratio	95%CI
Age (yr)	0.474	1.011	0.981-1.042
Male	0.068	1.986	0.951-4.149
BMI (kg/m2)	0.036	1.113	1.007-1.229
ASA classification
Ι	0.723	0.733	0.132-4.066
ΙΙ	0.373	1.532	0.599-3.920
ΙΙΙ		Reference
History of hepatobiliary and pancreatic disease	0.368	0.669	0.278-1.607
Diabetes	0.368	0.669	0.278-1.607
Hypertension	0.071	1.813	0.950-3.460
Coronary artery disease	0.905	1.073	0.339-3.396
Cerebrovascular disease	0.714	0.786	0.218-2.837
Preoperative total bilirubin	0.324	1.001	0.999-1.003
Primary site
Pancreas	0.581	0.777	0.317-1.905
Bile duct	0.087	2.063	0.899-4.735
Duodenum	Reference
Surgeon
A	0.44	1.482	0.545-4.030
B	0.55	0.757	0.303-1.888
C	0.308	0.605	0.231-1.589
D	0.053	0.127	0.016-1.028
E	0.076	0.339	0.103-1.119
F		Reference
Overtime case	0.006	2.592	1.312-5.122
Reconstruction technique
Roux-en-Y		Reference
Child surgery	0.743	1.113	0.586-2.114
Pancreaticojejunostomy technique
Duct-to-mucosa	0.572	1.217	0.617-2.4
Invagination		Reference

BMI: Body mass index.

Table 6 P values, odds ratios, and selected 95%CI for pancreatic fistula from multivariate logistic regression models

Parameter	P value	Odds ratio	95%CI
BMI (kg/m2)	0.034	1.12	1.008-1.243
Primary site
Pancreas	0.773	0.873	0.346-2.201
Bile duct	0.062	2.273	0.960-5.380
Duodenum		Reference
Overtime case	0.004	2.803	1.382-5.685

BMI: Body mass index.

Table 7 Karolinska Sleepiness Scale of surgeons during overtime and non-overtime operations

	Control group	Overtime group	P value
KSS	1.95 ± 0.6	6.4 ± 1.0	0

KSS: Karolinska Sleepiness Scale.