PurposePostoperative serum hyperamylasemia (POH) is a part of the new, increasingly highlighted, definition for postpancreatectomy pancreatitis (PPAP). The aim of this study is to analyse if the biochemical changes of PPAP are differently associated with postoperative complications after distal pancreatectomy (DP) compared to pancreatoduodenectomy (PD). The textbook outcome (TO) was used as a summary measure to capture real world data. MethodsThe data were retrospectively extracted from a prospective clinical database. Patients with POH, defined as levels above our institution's upper limit of normal on postoperative day (POD) 1, after DP and the corresponding propensity score-matched cohort after PD were evaluated on postoperative complications by using logistic regression analyses. ResultsWe analysed 723 patients who underwent PD and DP over a period of nine years. After propensity score matching 384 patients (192 patients in each group) remained. POH was observed in 78 (41.1%) and 74 (39.4%) after PD and DP correspondingly. There was a significant increase of postoperative complications in the PD group: CDC≥3 (p<0.01vs. p=0.71), clinically relevant pancreatic fistula (POPF) (p<0.001 vs. p=0.2), postpancreatectomy hemorrhage (PPH) (p<0.001 vs. p=0.11) and length of hospital stay (p<0.001 vs p= 0.69) if POH occurred compared to the DP group. TO was significantly unlikely in cases with POH after PD compared to DP (p>0.001 vs. p=0.41). Further, POH was found to be an independent predictor for missing TO after PD (odds ratio [OR] 0.29; 95% CI 0.14-0.60; p<0.001), whereas this was not observed in patients after DP ([OR] 0.53; 95% CI 0.21-1.33; p=0.18). ConclusionAs a part of the definition for postoperative pancreatitis (PPAP), POH is a predictive indicator associated with postoperative complications after PD but not after DP.