Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy: A Case Series of 423 Patients

Abstract

The study aimed to investigate the risk factors of postpancreatectomy hemorrhage (PPH) after pancreaticoduodenectomy (PD). A retrospective analysis of 423 patients who underwent PD between January 2008 and January 2014 was conducted. The overall incidence and all-cause mortality of PPH were 9.9% (42/423) and 2.1% (9/423), respectively. Independent risk factors of early PPH were revascularization (odds ratio (OR) = 6.786; 95% confidence interval (95% CI): 1.785–25.792; P = 0.005), history of abdominal surgery (OR = 5.009; 95% CI: 1.968–12.749; P = 0.001), and preoperative albumin levels (OR = 4.863; 95% CI: 1.962–12.005; P = 0.001). Independent risk factors of late PPH included postoperative pancreatic leakage (OR = 4.696; 95% CI: 1.605–13.740; P = 0.005), postoperative biliary fistula (OR = 6.096; 95% CI: 1.575–23.598; P = 0.009), postoperative abdominal infection (OR = 4.605; 95% CI: 1.108–19.144; P = 0.036), revascularization (OR = 9.943; 95% CI: 1.900–52.042; P = 0.007), history of abdominal surgery (OR = 8.790; 95% CI: 2.779–27.806; P < 0.001), and preoperative albumin levels (OR = 5.563; 95% CI: 1.845–16.776; P = 0.002).

Perioperative albumin ratio is associated with post‐operative pancreatic fistula

“…This parameter has been purposed as predictive factor for risk of fistula in previous series, but no accordance has been reached for the best cut-off value. [21][22][23][24] Metabolic status assessment have been demonstrated as a predictive factor for outcome in patients with pancreatic cancer and other neoplasms, affecting overall survival and disease free survival; the most common parameter analysed as expression of metabolic status is serum albumin. 20 POD3 amylase level in drainage fluid appears to be more predictive in our study than POD1 level probably because amylase levels in the drain effluent on POD1 may reflect alleged transient pancreatic leakage from the right-angle branches.…”

“…The role of nutritional and metabolic status is still controversial in large series analysing risk factors for POPF. [21][22][23][24] Metabolic status assessment have been demonstrated as a predictive factor for outcome in patients with pancreatic cancer and other neoplasms, affecting overall survival and disease free survival; the most common parameter analysed as expression of metabolic status is serum albumin. [7][8][9] The present study showed a significant correlation between POD1 serum albumin and POPF at univariate analysis, while preoperative values didn't show significant differences between patients with and without POPF ( Table 2); these data have been previously reported in large series but not confirmed in randomized trials.…”

Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

“…Although the frequency of postpancreatectomy hemorrhage (PPH) is not high, it results in severe adverse outcomes. The incidence rate of PPH and the mortality rate following PPH have been reported to be 3-16% and 16-36%, respectively [4][5][6][7][8][9][10][11][12]. The International Study Group on Pancreatic Surgery (ISGPS) defined PPH in 2007 [13].…”

Intra‐abdominal hemorrhage following 739 consecutive pancreaticoduodenectomy: Risk factors and treatments

“…The mostly well‐accepted definition and classification about PPH has been proposed by the International Study Group of Pancreatic Surgery (ISGPS) . With progress of the less invasive techniques, such as endoscopy and angiography, several studies have recommended treatment algorithm for PPH . However, most studies were limited by small sample size, and the treatment strategies varied largely due to different etiologies.…”

“…15 With progress of the less invasive techniques, such as endoscopy and angiography, several studies have recommended treatment algorithm for PPH. [16][17][18] However, most studies were limited by small sample size, and the treatment strategies varied largely due to different etiologies. On account of the poor prognosis of PPH despite improvements in diagnosis and treatment, identifying risk factors of PPH is of importance.…”