Risk factors for major intraoperative bleeding during pancreaticoduodenectomy and the impact of bleeding on postoperative outcome

Abstract

Background: Pancreaticoduodenectomy (PD) is a complex surgical procedure associated with a high risk for complications. The aim was to identify preoperative risk factors for patients with major intraoperative blood loss and to outline the postoperative outcomes. Methods: Patients registered in the Swedish National Quality Registry for Pancreatic and Periampullary Cancer that underwent PD 2011-2016 were included. Major intraoperative bleeding was defined as ≥1000 ml (4th quartile). Results: In total 1,864 patients were included. The median blood loss was 600 ml, and 502 patients had a bleeding ≥ 1000ml. The transfusion rate in the group with major bleeding was 56% (control group 9%). Preoperative independent risk factors associated with major bleeding were BMI (p<0.001), diabetes (p=0.044), biliary drainage (p<0.001), and neo-adjuvant treatment (p=0.002). Further, operative time was longer (p=0.013), and vascular resection more common (p=0.016). Postoperative ICU stay (p<0.001), reoperations (p=0.035), surgical infections (p=0.036), and bile leakage (p=0.045) were more common in the group with major bleeding, but not complications like pancreatic fistula and delayed gastric emptying. The 30-day mortality was 5% compared to 1.6% in the control group (p<0.001). Conclusion: Independent risk factors for intraoperative blood loss during PD could be identified. The tumors were more advanced, based on a higher proportion of venous resection. Postoperative surgical infections and bile leakage were more frequently noted.