The impact of heart disease on postoperative complications after pancreaticoduodenectomy

Abstract

Purpose: Comorbidity increases the risk for postoperative complications after pancreatic surgery. However, the impact of different heart diseases on postoperative outcome after pancreaticoduodenectomy (PD) has not been thoroughly studied. Methods: All patients aged ≥18 years who underwent PD (2008 – 2019) at Karolinska University Hospital were retrospectively analysed. Heart disease was defined as presence of a preoperative cardiac diagnosis (according to the International Statistical Classification of Diseases and Related Health Problems, ICD, 10th version) and categorised in groups: atrial fibrillation, heart failure, ischemic heart disease and valvular disease. Postoperative morbidity and mortality were analysed by multivariable logistic regression. Results: Overall, 971 patients were included and 225 had at least one preoperative cardiac diagnosis. Heart disease was associated with increased risk of Clavien-Dindo ≥ IIIa (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.07-2.18; p=0.019), longer median hospital stay (14 vs. 11 days; p<0.001), risk of intensive care unit (ICU) admission (OR 3.20, 95% CI 1.81-5.66; p<0.001) and delayed gastric emptying grade B-C (OR 1.45, 95% CI 1.03-2.04; p=0.031). There was no difference in 30-day mortality, however, patients with heart disease had a shorter median overall survival (22 vs. 32 months; p<0.001). Atrial fibrillation, heart failure and ischemic heart disease were independently associated with increased risk for complications whereas valvular disease was not. Conclusion: Ischemic heart disease, atrial fibrillation and heart failure was associated with increased risk for postoperative complications after PD. No difference in short term survival was observed but patients with heart disease had a shorter median overall survival.