Early hyperlactatemia predicts pancreatic fistula after surgery.

Nicolas De Schryver,Jean-François Gigot,Pierre-François Laterre,Xavier Wittebole,Diego Castanares-Zapatero,Catherine Hubert

doi:10.1186/s12871-015-0093-x

Nicolas De Schryver, Jean-François Gigot + Show 4 more

Open Access

https://doi.org/10.1186/s12871-015-0093-x

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Abstract

BackgroundPostoperative pancreatic fistula (POPF) is a major complication after pancreatic surgery and results from an impaired healing of the pancreatic enteric anastomosis. Whether perioperative hemodynamic fluid management aiming to provide an adequate tissue perfusion could influence the occurrence of POPF is unknown. Serum lactate level is a well-recognized marker of decreased tissue perfusion and is known to be associated with higher morbidity and mortality in various postoperative settings. We aimed to determine in a retrospective high-volume center’s cohort whether postoperative hyperlactatemia could predict POPF occurrence.MethodWe conducted a retrospective analysis of 96 consecutive patients admitted in the intensive care unit (ICU) after pancreaticoduodenectomy or distal pancreatectomy. Univariate analysis was conducted to compare lactate levels at 6 h between patients evolving with versus without POPF. A logistic regression model was developed and included potential confounding factors.ResultsPOPF occurred in 28 patients (29 %). Serum lactate level 6 h after admission was significantly higher in the POPF group (2.8 mmol/L [95 % confidence interval (CI): 2.1–3.5] versus 1.8 mmol/L [95 % CI: 1.8–2.4], p-value = 0.04) whereas it did not differ at ICU admission or at 12 h. Despite similar cumulative fluid balance, fluid intake and vasopressor use, hyperlactatemia > 2.5 mmol/L (Odds ratio (OR): 3.58; 95 % CI: 1.22–10.48; p-value = 0.020) and red blood cells transfusion (OR: 1.24; 95 % CI: 1.03–1.49; p-value = 0.022) were found to be independent predictive factors of POPF occurrence.ConclusionIn patients undergoing partial pancreatectomy, hyperlactatemia measured 6 h after ICU admission is a predictive factor for the occurrence of POPF. Inflammatory changes after surgery may account for this observation and should be further evaluated.

Highlights

Postoperative pancreatic fistula (POPF) is a major complication after pancreatic surgery and results from an impaired healing of the pancreatic enteric anastomosis
Serum lactate level 6 h after admission was significantly higher in the POPF group (2.8 mmol/L [95 % confidence interval (CI): 2.1–3.5] versus 1.8 mmol/L [95 % CI: 1.8–2.4], p-value = 0.04) whereas it did not differ at intensive care unit (ICU) admission or at 12 h
Body mass index (BMI) was significantly higher in patients evolving with POPF

Summary

Introduction

Postoperative pancreatic fistula (POPF) is a major complication after pancreatic surgery and results from an impaired healing of the pancreatic enteric anastomosis. While pancreaticoduodenectomy is used for pancreatic head resection, Though mortality has declined over the last decades, morbidity rates remain substantial, reaching 30 to 50 % even in high-volume centers [6,7,8,9]. Morbidity most commonly results from postoperative pancreatic fistula (POPF). POPF is caused by a deficient healing of the pancreatic-enteric anastomosis, leading to partial or complete anastomotic dehiscence. While a low-grade fistula is a transient leak that does not require specific treatment, externalized pancreatic juice may lead to life-threatening complications, De Schryver et al BMC Anesthesiology (2015) 15:109 such as intra-abdominal sepsis or hemorrhage. POPF substantially contributes to increased hospitalization length of stay, as percutaneous drainage of abdominal collection or surgical re-exploration is often required in these cases

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