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Am J Surg. 2020 Mar;219(3):390-393. doi: 10.1016/j.amjsurg.2019.10.043. Epub 2019 Nov 12.

Two open whipples a day: Excessive or efficient.

Author information

1
Indiana University School of Medicine Department of Surgery, Indianapolis, IN, USA.
2
Center for Outcomes Research in Surgery, Indianapolis, IN, USA.
3
Indiana University School of Medicine Department of Surgery, Indianapolis, IN, USA; Indiana University School of Medicine Department of Biochemistry/Molecular Biology, Indianapolis, IN, USA. Electronic address: maxschmi@iupui.edu.

Abstract

BACKGROUND:

Demand for pancreatic surgery is rising, occasionally necessitating consecutive PDs to be performed by a single surgeon in the same workday. The safety of this practice is unknown.

METHODS:

Institutional prospective ACS-NSQIP data were reviewed for PDs (2013-2017). Instances where a single surgeon performed two PDs in the same day were a PD pair (PD1, PD2) and compared with univariable analysis. Paired vs. unpaired-PD matched analyses were performed.

RESULTS:

661 PDs (25-PD pairs) were performed. PD1 and PD2 revealed similar infectious (12% vs16%), pulmonary (8% vs8%), cardiovascular (12% vs4%), and aggregate (24% vs24%) morbidity (P>0.05). Pancreatic fistula (B + C 0%), delayed gastric emptying (4% vs12%), hospital stay (9.3 vs8.8 days), and 30-day mortality (4% vs4%) were similar (P > 0.05). Matched outcomes were similar except higher cardiovascular morbidity for paired vs. unpaired PD (7% vs0%; P = 0.015).

CONCLUSION:

With proper patient selection, and in experienced hands at high-volume centers, two consecutive open PDs may be safely performed.

KEYWORDS:

Pancreatoduodenectomy; Safety; Surgical outcomes

Conflict of interest statement

Declaration of competing interest None declared.

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