World Journal of Surgery

, Volume 43, Issue 2, pp 385–394 | Cite as

Hypophosphatemia as a Predictor of Organ-Specific Complications Following Gastrointestinal Surgery: Analysis of 8034 Patients

  • Eran Sadot
  • Jian Zheng
  • Rami Srouji
  • Vivian E. Strong
  • Mithat Gönen
  • Vinod P. Balachandran
  • Michael I. D’Angelica
  • Peter J. Allen
  • Ronald P. DeMatteo
  • T. Peter Kingham
  • Yuman Fong
  • Martin R. Weiser
  • William R. JarnaginEmail author
Original Scientific Report



Organ-specific complications (OSC) remain serious potential sequela of gastrointestinal surgery. Hypophosphatemia correlates with poor outcomes and may be a harbinger of OSC after gastrointestinal surgery. Our goal was to describe and evaluate the relationship between postoperative phosphate levels and OSC.


Consecutive patients who underwent pancreatic, colorectal, or gastric resections were analyzed. OSC were defined as those resulting from the failure of at least one anastomosis performed during the primary resection, manifesting as an anastomotic leak, fistula, and/or intra-abdominal abscess. Postoperative serum phosphate levels and other recognized OSC risk factors were compared among patients who did and did not develop OSC.


A total of 8034 patients who underwent pancreatic (n = 397), colorectal (n = 5808), or gastric (n = 1829) resections were included in the study. In each resection group, the majority of patients experienced hypophosphatemia postresection with the nadir on postoperative day (POD) 2, and the subgroups that developed OSC exhibited lower phosphate levels on POD3–7. On multivariate analysis, lower phosphate level on POD3 remained significantly associated with OSC following pancreatic resection [median (interquartile range) mmol/L, 0.65 (0.53–0.76) vs. 0.71 (0.61–0.84), p = 0.045] and colorectal resection [0.71 (0.61–0.87) vs. 0.77 (0.65–0.94), p = 0.006], and lower phosphate level on POD4 remained associated with OSC following gastric resection [0.87 (0.74–1.03) vs. 0.96 (0.81–1.13), p = 0.049].


This study identified a consistent trajectory of serum phosphate levels following 3 different gastrointestinal operations and association between early postoperative phosphate levels and OSC. Persistent lower phosphate levels should raise the level of concern for evolving postoperative leak and may lead to earlier radiographic evaluation and treatment.



Organ-specific complications


Postoperative day


Leak-related complications


Intra-abdominal infection


Chronic kidney disease epidemiology collaboration


Glomerular filtration rate


White blood cell counts


Interquartile range


Body mass index


Pancreatic ductal adenocarcinoma


Intraductal papillary mucinous neoplasm


Pancreatic neuroendocrine tumor


Nicotinamide phosphoribosyltransferase


Enhanced recovery after surgery



Funded in part by the NIH/NCI Cancer Center Support Grant P30 CA008748.

Compliance with ethical standards

Conflict of interest

All authors report no conflict of interests regarding this study.

Supplementary material

268_2018_4726_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 30 kb)


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Copyright information

© Société Internationale de Chirurgie 2018
Corrected publication November/2018

Authors and Affiliations

  • Eran Sadot
    • 1
    • 2
    • 3
  • Jian Zheng
    • 1
  • Rami Srouji
    • 1
  • Vivian E. Strong
    • 1
  • Mithat Gönen
    • 4
  • Vinod P. Balachandran
    • 1
  • Michael I. D’Angelica
    • 1
  • Peter J. Allen
    • 1
  • Ronald P. DeMatteo
    • 1
  • T. Peter Kingham
    • 1
  • Yuman Fong
    • 1
    • 5
  • Martin R. Weiser
    • 1
  • William R. Jarnagin
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryRabin Medical CenterPetah TikvaIsrael
  3. 3.Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  5. 5.Department of SurgeryCity of HopeDuarteUSA

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