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Prognostic Factors of Winter et al for Evaluating a Patient Undergoing a Pancreaticoduodenectomy

Purpose: To identify prognostic factors for a patient undergoing pancreaticoduodenectomy.

Description

Winter et al identified preoperative prognostic factors for a patient about to undergo a pancreaticoduodenectomy. These can help identify patients who may benefit from more aggressive management or an alternative therapy. The authors are from Johns Hopkins University. Thomas Jefferson University, and Indiana University.


Preoperative predictors of postoperative complications:

(1) BUN >= 18 mg/dL

(2) serum albumin <= 3.5 g/dL

 

Postoperative predictors of postoperative complications:

(1) peak serum amylase >= 292 U/L

 

Predictors of postoperative death:

(1) preoperative serum albumin <= 3.5 g/dL

(2) peak postoperative aminotransferase >= 187 U/L

 

where:

• The peak postoperative aminotransferase was the maximum AST or ALT within 3 days of the operation.

• The peak postoperative amylase was the maximum concentration within 2 days of the operation.

• An elevated peak postoperative serum amylase was associated with an increased risk of pancreatic fistula, up to 20% for a peak amylase >= 400 U/L.

 

Preoperative Serum Albumin

Mortality Rate

> 3.5 g/dL

1%

2.6 to 3.5 g/dL

3%

< 2.6 g/dL

7%

 

 

Preoperative Aminotransferase

Mortality Rate

< 500 U/L

1%

500 to 1,999 U/L

5%

>= 2,000 U/L

29%

 

Thus the low mortality risk patient has a preoperative serum albumin > 3.5 g/dL and a postoperative peak aminotransferase < 500 U/L.


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Specialty

Objective

ICD-10