BACKGROUND: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication of pancreatic resection. Most published series span decades and do not reflect contemporary practice. This study analyzes the rate, management, and outcomes of PPH during a recent 5-year period. STUDY DESIGN: Patients in whom PPH developed between 2006 and 2011 were identified from a prospective database. Postpancreatectomy hemorrhage was defined as evidence of bleeding associated with a drop in hemoglobin (≥ 3 g/dL) and/or clinical signs of hemodynamic compromise, and categorized as early or late (<24 hours or >24 hours from operation). Demographics and operative and perioperative outcomes were analyzed using standard descriptive statistics. RESULTS: Overall incidence of PPH was 3% (33 of 1,122 pancreatectomies) and was similar for pancreaticoduodenectomy (25 of 739 [3%]), distal (6 of 350 [2%]), and central pancreatectomy (2 of 31 [6%]) (p = 0.26). Early hemorrhage was seen in 21% (7 of 33) and was always extraluminal; these patients underwent reoperation and recovered fully. Late hemorrhage (26 of 33 [79%]) was predominantly intraluminal (18 of 26 [69%]), occurring at a median of 12 days postoperatively (4 to 23 days), and was treated endoscopically (13 of 26 [50%]), angiographically (10 of 26 [38%]), or surgically (3 of 26 [10%]). Postpancreatectomy hemorrhage was associated with longer hospitalization (10 [range 8 to 17] days vs 7 [range 6 to 9] days; p < 0.01); mortality, however, was not increased (1 of 33 [3%] vs 17 of 1,089 [2%]; p = 0.95). Hemorrhage began after discharge in 39% of patients (13 of 33), with the only death occurring in a patient from this group. CONCLUSIONS: Postpancreatectomy hemorrhage can be managed successfully with low mortality (3%). Early hemorrhage requires urgent reoperation, and management of delayed hemorrhage should be guided by location (intra- vs extraluminal). Greater pressure to reduce length of hospital stay appears to have increased the likelihood of PPH occurring after discharge; patients and physicians should be aware of this possibility.
BACKGROUND: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication of pancreatic resection. Most published series span decades and do not reflect contemporary practice. This study analyzes the rate, management, and outcomes of PPH during a recent 5-year period. STUDY DESIGN:Patients in whom PPH developed between 2006 and 2011 were identified from a prospective database. Postpancreatectomy hemorrhage was defined as evidence of bleeding associated with a drop in hemoglobin (≥ 3 g/dL) and/or clinical signs of hemodynamic compromise, and categorized as early or late (<24 hours or >24 hours from operation). Demographics and operative and perioperative outcomes were analyzed using standard descriptive statistics. RESULTS: Overall incidence of PPH was 3% (33 of 1,122 pancreatectomies) and was similar for pancreaticoduodenectomy (25 of 739 [3%]), distal (6 of 350 [2%]), and central pancreatectomy (2 of 31 [6%]) (p = 0.26). Early hemorrhage was seen in 21% (7 of 33) and was always extraluminal; these patients underwent reoperation and recovered fully. Late hemorrhage (26 of 33 [79%]) was predominantly intraluminal (18 of 26 [69%]), occurring at a median of 12 days postoperatively (4 to 23 days), and was treated endoscopically (13 of 26 [50%]), angiographically (10 of 26 [38%]), or surgically (3 of 26 [10%]). Postpancreatectomy hemorrhage was associated with longer hospitalization (10 [range 8 to 17] days vs 7 [range 6 to 9] days; p < 0.01); mortality, however, was not increased (1 of 33 [3%] vs 17 of 1,089 [2%]; p = 0.95). Hemorrhage began after discharge in 39% of patients (13 of 33), with the only death occurring in a patient from this group. CONCLUSIONS: Postpancreatectomy hemorrhage can be managed successfully with low mortality (3%). Early hemorrhage requires urgent reoperation, and management of delayed hemorrhage should be guided by location (intra- vs extraluminal). Greater pressure to reduce length of hospital stay appears to have increased the likelihood of PPH occurring after discharge; patients and physicians should be aware of this possibility.
Authors: A Sanchez Arteaga; M I Orue-Echebarria; L Zarain; A Lusilla; C M Martinez; A Moreno; M Cuadrado; C Rey; M D Perez Diaz; M G Leyte; F J Turégano Journal: Eur J Trauma Emerg Surg Date: 2016-04-21 Impact factor: 3.693
Authors: U F Wellner; B Kulemann; H Lapshyn; J Hoeppner; O Sick; F Makowiec; D Bausch; Ulrich Theodor Hopt; T Keck Journal: J Gastrointest Surg Date: 2014-01-22 Impact factor: 3.452
Authors: Gyulnara G Kasumova; Mariam F Eskander; Tara S Kent; Sing Chau Ng; A James Moser; Muneeb Ahmed; Douglas K Pleskow; Mark P Callery; Jennifer F Tseng Journal: HPB (Oxford) Date: 2016-08-11 Impact factor: 3.647
Authors: Ching-Wei D Tzeng; Matthew H G Katz; Jeffrey E Lee; Jason B Fleming; Peter W T Pisters; Jean-Nicolas Vauthey; Thomas A Aloia Journal: HPB (Oxford) Date: 2013-07-22 Impact factor: 3.647
Authors: Kengo Asai; Victor Zaydfudim; Mark Truty; K Marie Reid-Lombardo; Michael Kendrick; Florencia Que; David Nagorney; James Andrews; Michael Farnell Journal: HPB (Oxford) Date: 2015-07-31 Impact factor: 3.647