Contemporary experience with postpancreatectomy hemorrhage: results of 1,122 patients resected between 2006 and 2011

Abstract

Background: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication of pancreatic resection. Most published series span decades and do not reflect contemporary practice. This study analyzes the rate, management, and outcomes of PPH during a recent 5-year period.

Study design: Patients in whom PPH developed between 2006 and 2011 were identified from a prospective database. Postpancreatectomy hemorrhage was defined as evidence of bleeding associated with a drop in hemoglobin (≥ 3 g/dL) and/or clinical signs of hemodynamic compromise, and categorized as early or late (<24 hours or >24 hours from operation). Demographics and operative and perioperative outcomes were analyzed using standard descriptive statistics.

Results: Overall incidence of PPH was 3% (33 of 1,122 pancreatectomies) and was similar for pancreaticoduodenectomy (25 of 739 [3%]), distal (6 of 350 [2%]), and central pancreatectomy (2 of 31 [6%]) (p = 0.26). Early hemorrhage was seen in 21% (7 of 33) and was always extraluminal; these patients underwent reoperation and recovered fully. Late hemorrhage (26 of 33 [79%]) was predominantly intraluminal (18 of 26 [69%]), occurring at a median of 12 days postoperatively (4 to 23 days), and was treated endoscopically (13 of 26 [50%]), angiographically (10 of 26 [38%]), or surgically (3 of 26 [10%]). Postpancreatectomy hemorrhage was associated with longer hospitalization (10 [range 8 to 17] days vs 7 [range 6 to 9] days; p < 0.01); mortality, however, was not increased (1 of 33 [3%] vs 17 of 1,089 [2%]; p = 0.95). Hemorrhage began after discharge in 39% of patients (13 of 33), with the only death occurring in a patient from this group.

Conclusions: Postpancreatectomy hemorrhage can be managed successfully with low mortality (3%). Early hemorrhage requires urgent reoperation, and management of delayed hemorrhage should be guided by location (intra- vs extraluminal). Greater pressure to reduce length of hospital stay appears to have increased the likelihood of PPH occurring after discharge; patients and physicians should be aware of this possibility.