Updates in Surgery

, Volume 71, Issue 4, pp 659–667 | Cite as

Analysis of risk factors for hemorrhage and related outcome after pancreatoduodenectomy in an intermediate-volume center

  • Fabio UggeriEmail author
  • Luca Nespoli
  • Marta Sandini
  • Anita Andreano
  • Luca Degrate
  • Fabrizio Romano
  • Laura Antolini
  • Luca Gianotti
Original Article


Precise risk factors for bleeding after pancreatoduodenectomy (PD) need to be further explored. We aimed to identify which variables were associated with the risk of post-pancreatectomy hemorrhage (PPH) and benchmark the PPH rate and related outcome in our intermediate-volume center with the current literature. We retrospectively analyzed 183 PD records. We investigated the association between PPH and a number of pre-surgical (age, body mass index, bilirubin plasma level, gender, American Society of Anesthesiologists classification (ASA) and smoking status, vascular hypertension), surgical (technique, additional organ resection, occlusion of the stump) and post-surgical (pancreatic fistula, bile leak and abscess development) risk factors with multivariable regression models. PPH episodes were classified and graded according to the International Study Group of Pancreatic Surgery. The overall PPH risk was 19.6%. Specific PPH mortality was 16.6%. Occurrence of PPH was increased in male patients (RR = 2.4, p = 0.001), with ASA ≥ 3 (RR = 2.1, p = 0.009) and hypertension (RR = 1.8, p = 0.04). Active smoking was protective (RR = 0.26, p = 0.001). Among postoperative factors, only pancreatic fistula increased the risk (RR = 1.6, p = 0.034). Early PPH was associated with the type of surgical reconstruction (RR 4.02, 95% CI 1.41–11.44, p = 0.009) and late PPH with pancreatic fistula (RR 2.88, 95% CI 1.06–7.83, p = 0.038). For grade C PPH, the impact of pancreatic fistula was greater (RR = 2.8, p = 0.04). Pancreatic fistula plays a crucial role in the pathogenesis of PPH. In addition, male gender, ASA ≥ 3 and hypertension increase the risk of PPH, while smoking appears protective. The PPH risk and subsequent consequences are at an acceptable rate in an intermediate-volume center.


Pancreatoduodenectomy Postoperative hemorrhage Risk factors Mortality Center volume 


Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Research involving human participants and/or animals

The study protocol followed the ethical guidelines of the 1975 Declaration of Helsinky (as revised in Brazil 2013). The local Ethical Committee review of the protocol deemed that formal approval was not required owing to the retrospective, observational and anonymous nature of the study.

Informed consent

Under the italian law, anonymous and retrospective studies do not require formal approval by ethics committee and they do not require a patient's informed consent.


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Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  1. 1.Department of Surgery, School of Medicine and Surgery, San Gerardo HospitalUniversity of Milano-BicoccaMonzaItaly
  2. 2.Center of Biostatistics for Clinical Epidemiology, School of Medicine and SurgeryUniversity of Milano-BicoccaMonzaItaly

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