Differences in grade C postpancreatectomy hemorrhage with or without clinically relevant pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study

Abstract

Background: Pancreatic fistula is a major cause of late postpancreatectomy hemorrhage; however, it is not always accompanied by a postoperative pancreatic fistula, indicating other potential etiologies and characteristics. We investigated the role of clinically relevant postoperative pancreatic fistula in grade C postpancreatectomy hemorrhage and its potential as a classification criterion.

Methods: In this retrospective cohort study, we identified patients who developed grade C postpancreatectomy hemorrhage with or without concomitant clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy at the First Affiliated Hospital of Nanjing Medical University between January 2014 and December 2023. The patients' demographics, bleeding patterns, and outcomes were retrieved from their medical records and analyzed.

Results: Overall, 90 patients with grade C postpancreatectomy hemorrhage (52 [57.8%] with clinically relevant postoperative pancreatic fistula) were included in this study. Patients with clinically relevant postoperative pancreatic fistula had longer bleeding intervals (13.5 vs 7 days; P = .007). Although the gastroduodenal artery stump (32.7%) was the most common bleeding site in the fistula group, the hepatic artery and its branches (23.7%) and other bleeding points in the surgical area (23.7%) were predominant in the non-fistula group (P = .041). The fistula group had a greater mortality rate (38.5% vs 10.5%; P = .003), longer median length of hospital stay (42 vs 30 days; P = .047), longer intensive care unit stay (2 vs 0 days; P = .004), and greater hospitalization costs (RMB 283,632.73 vs RMB 189,087.6; P = .004).

Conclusion: The bleeding patterns and outcomes of grade C postpancreatectomy hemorrhage with and without concomitant clinically relevant postoperative pancreatic fistula varied. Therefore, postoperative pancreatic fistula could be considered as a new classification criterion for late postpancreatectomy hemorrhage.