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. 2019 Dec;404(8):967-974.
doi: 10.1007/s00423-019-01830-w. Epub 2019 Oct 24.

Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

Wataru Izumo  1 , Ryota Higuchi  2 , Takehisa Yazawa  1 , Shuichiro Uemura  1 , Masahiro Shiihara  1 , Masakazu Yamamoto  1
Affiliations

Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

Wataru Izumo et al. Langenbecks Arch Surg. 2019 Dec.

Abstract

Purpose: To investigate the risk factors for post-pancreatectomy hemorrhage (PPH).

Methods: The incidence, outcome, and risk factors for PPH were evaluated in 1169 patients who underwent pancreatectomy.

Results: The incidence and mortality rates of PPH were 3% and 11% in all pancreatectomies, 4% and 11% in pancreatoduodenectomy, 1% and 20% in distal pancreatectomy, and 3% and 0% in total pancreatectomy, respectively. Male sex [odds ratio (OR) 2.32], body mass index (BMI) ≥ 25 kg/m2 (OR 3.70), absence of diabetes mellitus (DM; HbA1c ≤ 6.2%; OR 3.62), and pancreatoduodenectomy (OR 3.06) were risk factors for PPH after all pancreatectomies. The PPH incidence was 0%, 1%, 2%, 6%, and 20% in patients with risk scores of 0 (n = 65), 1 (n = 325), 2 (n = 455), 3 (n = 299), and 4 (n = 25), respectively. The differences between risk-score groups 0-2 (2%) and 3-4 (7%) were significant (P < 0.05, OR 4.7). In patients who had undergone pancreatoduodenectomy, postoperative pancreatic fistula (POPF; OR 31.7) and absence of DM (OR 3.45) were risk factors for PPH. There was no significant association between POPF and PPH after distal pancreatectomy (P = 0.28). The incidence of POPF post-pancreatoduodenectomy was 20%. BMI ≥ 25 kg/m2 (OR 3.17), serum albumin < 3.5 g/dl (OR 1.77), absence of DM (OR 1.75), distal extrahepatic bile duct carcinoma (OR 4.05), and carcinoma of the papilla of Vater (OR 5.19) were risk factors for POPF post-pancreatoduodenectomy.

Conclusion: Our study clarified the preoperative risk factors for PPH and recommends using a risk scoring system that includes "absence of DM" for predicting PPH.

Keywords: Pancreatic fistula; Pancreatoduodenectomy; Post-pancreatectomy hemorrhage; Preoperative; Risk factor.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

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