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30-Day outcomes and predictors of complications after Puestow procedure

Michael Napolitano, Fred Brody, Kyongjune Benjamin Lee, Ethan Rosenfeld, Sheena Chen, Alejandro Ernesto Murillo-Berlioz, Richard Amdur
American Journal of Surgery 2020, 220 (2): 372-375

BACKGROUND: A lateral pancreaticojejunostomy, or a Puestow procedure, is used in chronic pancreatitis with ductal dilation and pain. The current literature on the Puestow is sparse. This study examines outcomes of Puestow procedures nationwide.

METHODS: Using ACS-NSQIP database, patients who underwent a Puestow procedure from 2010 to 2016 were identified. Univariate analysis and multivariable regression models were used to identify predictors of mortality and morbidities. Covariates included in the regression models were chosen based on clinical significance.

RESULTS: The cohort included 524 patients. The 30-day mortality rate was 1.2%(n = 6). At least one major complication occurred in 19.1% of patients including death (1.2%), major organ dysfunction (8.2%), pulmonary embolism (1.3%), and surgical site infections (13.0%). Diabetes, COPD, and transfusions were the strongest predictors of complications.

CONCLUSIONS: The Puestow procedure is an acceptable treatment modality with low rates of morbidity and mortality. Minimizing transfusions and optimizing pulmonary status may improve 30-day outcomes.

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