Biochemical Markers Predict Morbidity and Mortality after Pancreaticoduodenectomy

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Abstract
The association between routinely ordered perioperative laboratory tests and postoperative morbidity and mortality after pancreaticoduodenectomy has not been well characterized. Routine perioperative laboratory data were analyzed for 2,894 patients who underwent a pancreaticoduodenectomy over a 25-year period. Laboratory values were initially categorized as being above or below the 75th percentile for the study population, and biochemical markers of morbidity and mortality were identified using multivariate logistic regression. The most significant biochemical markers were studied in greater detail by regrouping patients into low, intermediate, and high categories. Significant multivariate predictors of a postoperative complication included preoperative blood urea nitrogen ≥ 18 mg/dL, preoperative albumin ≤ 3.5 g/dL, and postoperative amylase ≥ 292 U/L. Significant multivariate predictors of a postoperative death included preoperative albumin ≤ 3.5 g/dL and postoperative aminotransferase ≥ 187 U/L. Postoperative hyperamylasemia was found to be associated, in particular, with an increased pancreatic fistula rate. Pancreatic fistula rates in the low (0 to 99 U/L), intermediate (100 to 399 U/L), and high (≥ 400 U/L) postoperative amylase groups were 4%, 14%, and 20%, respectively. Postoperative mortality rates in patients with low (0 to 499 U/L), intermediate (500 to 1,999 U/L), and high (≥ 2,000 U/L) postoperative aminotransferase groups were 0.9%, 5%, and 29%, respectively. Postoperative mortality rates in the high (> 3.5g/dL), intermediate (2.6 to 3.5g/dL), and low (0 to 2.5g/dL) albumin groups were 0.9%, 3%, and 7%, respectively. Routine perioperative laboratory tests can help surgeons identify patients who are at increased risk for morbidity and mortality after pancreaticoduodenectomy.