Postpancreatectomy Hemorrhage: Risk Factors and Outcomes

Objective: To compare outcomes of patients with or without PPH and to identify risk factors associated with postoperative mortality. Background: Postpancreatectomy hemorrhage (PPH) remains one of the most harmful events after pancreatic resection. Methods: This analysis was conducted from a prospectively maintained database on patients who underwent elective pancreatic resection from 2001 to 2022. PPH rates and determinants were compared across resection types and mortality risk factors in PPH patients were identified through uni- and multivariable analyses. Results: Of 10,467 patients, 5,711 were men (54.6%); median age was 63 years (IQR, 54-71 y). The overall major morbidity rate was 22.7% with an in-hospital mortality of 3.2%. PPH occurred in 610 patients (5.9%). CR-POPF strongly predicted PPH (OR 5.93, 95% CI, 4.80–7.34; P <001). With increasing surgical complexity, PPH incidence and mortality increased from 5%/6% to 13%/36% ( P <0.001). Overall, PPH was associated with an almost 10-fold increase in mortality (20.7% vs 2.2%; P< 0.001). Independent risk factors for mortality in the PPH group after pancreatic head or distal resections were higher age (OR; 2.79, P= 0.001), relaparotomy for bleeding (OR, 6.35, 95% CI, 3.04-14.0; P< 0.001), bleeding from the SMA (OR, 3.92; P= 0.07) or the hepatic artery (OR, 3.05; P= 0.02), sepsis (OR, 4.10; P< 0.001) and very late (POD ≥16) bleeding (OR, 3.95; P= 0.03). After total pancreatectomy, only recurrent bleeding (OR, 2.36; P= 0.07) and intraabdominal infection (OR, 3.10; P= 0.22) were identified as independent predictors for mortality. Conclusions: The occurrence of PPH represents the most severe complication after pancreatic resection and is associated with an almost 10-fold increase in mortality. This effect is even more pronounced in patients undergoing more complex resections.