Detailed Abstract
[Oral Presentation 6 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[OP 6-2] Postoperative serum hyperamylasemia (POH) predicts additional morbidity after pancreatoduodenectomy. It is not all about pancreatic fistula
Elisa BANNONE1 , Giovanni MARCHEGIANI*1 , Giampaolo PERRI1 , Giuseppa PROCIDA1 , Piero VACCA1 , Alice CATTELANI1 , Roberto SALVIA1
1 General And Pancreatic Surgery, University Of Verona Hospital Trust, ITALY
Background : The association between postoperative serum hyperamylasaemia (POH) and morbidity has been hypothesized but rarely explored once occurring with or without a combined postoperative pancreatic fistula (POPF).
Methods : Analysis of patients who consecutively underwent pancreaticoduodenectomy from 2016 to 2020. POH was defined as serum amylase activity greater than the institutional upper limit of normal (52 U/l), persisting within at least the first 48 hours postoperatively (postoperative day ?POD? 1 and 2).
Results : Among 852 patients, 15.8% developed POH-exclusive. Compared to patients without POH or POPF, they showed a significantly higher postoperative burden (Clavien-Dindo ≥ II: 52.6% vs. 30.8%) with increased rates of bacteraemia (12.6% vs 6%), pleural effusion (13.3% vs 5.3%), postpancreatectomy haemorrhage (13.3% vs 7.5%), and organ site infections (18.5% vs 10.9%), all p < 0.05. A total of 13.8% experienced POH with POPF leading to the worse outcome. The combined occurrence of POH with POPF led to a shorter median time to morbidity (3 PODs, 95% IC 2.2-3.7 vs. 6 PODs, 95% IC 4.2-8; p <0.001) than patients experiencing POPF-exclusive. BMI (OR 1.1), male sex (OR 2.1), increased drain fluid amylase on POD 1 (OR 1.001), and increased C-reactive protein (OR 1.01) were independent risk factors for POPF once POH has occurred.
Conclusions : POH has relevant postoperative clinical implications, independently from POPF occurrence. Developing POH with POPF leads to an earlier onset of a higher postoperative burden. Once POH is diagnosed, risk factors for additional POPF could identify patients who may benefit from additional surveillance and preventive strategies.
Methods : Analysis of patients who consecutively underwent pancreaticoduodenectomy from 2016 to 2020. POH was defined as serum amylase activity greater than the institutional upper limit of normal (52 U/l), persisting within at least the first 48 hours postoperatively (postoperative day ?POD? 1 and 2).
Results : Among 852 patients, 15.8% developed POH-exclusive. Compared to patients without POH or POPF, they showed a significantly higher postoperative burden (Clavien-Dindo ≥ II: 52.6% vs. 30.8%) with increased rates of bacteraemia (12.6% vs 6%), pleural effusion (13.3% vs 5.3%), postpancreatectomy haemorrhage (13.3% vs 7.5%), and organ site infections (18.5% vs 10.9%), all p < 0.05. A total of 13.8% experienced POH with POPF leading to the worse outcome. The combined occurrence of POH with POPF led to a shorter median time to morbidity (3 PODs, 95% IC 2.2-3.7 vs. 6 PODs, 95% IC 4.2-8; p <0.001) than patients experiencing POPF-exclusive. BMI (OR 1.1), male sex (OR 2.1), increased drain fluid amylase on POD 1 (OR 1.001), and increased C-reactive protein (OR 1.01) were independent risk factors for POPF once POH has occurred.
Conclusions : POH has relevant postoperative clinical implications, independently from POPF occurrence. Developing POH with POPF leads to an earlier onset of a higher postoperative burden. Once POH is diagnosed, risk factors for additional POPF could identify patients who may benefit from additional surveillance and preventive strategies.
SESSION
Oral Presentation 6
Room A 3/5/2022 10:10 AM - 11:00 AM