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Impact of pulmonary embolism on morbidity and mortality in patients undergoing pancreatic surgery

Langenbeck's Archives of Surgery volume 406, pages 893–902 (2021)Cite this article

Abstract

Purpose

Postoperative pulmonary embolism (PE) after pancreatic surgery is a potentially life-threatening complication. However, the magnitude of morbidity and mortality of PE is still uncertain. The present study aims to assess the incidence of PE after pancreatic surgery and analyze its impact on the outcome.

Methods

We conducted a retrospective study including all patients who underwent pancreatic resections between 2005 and 2017. The development of PE was analyzed for a 90-day period following surgery. Risk factors were evaluated using regression models.

Results

The study investigated 947 patients undergoing pancreatic surgery. Overall, 26 (2.7%) patients developed PE. The median body mass index (BMI) of patients with PE was significantly higher (28.1 kg/m2 [24.7–31.8] vs. 24.8 kg/m2 [22.4–27.8], p < 0.001). Patients with PE had a significantly increased duration of the operation and more often underwent multivisceral resections. The lowest incidence of PE was found after distal or total pancreatectomy (2%). In median, PE occurred on the fifth postoperative day (interquartile range: 3–9). Increased BMI, duration of operation, and postoperative deep venous thrombosis were found to be multivariate risk factors for the development of PE. Importantly, postoperative complications (53.8% vs. 15.1%, p < 0.001) and the 30-day mortality rate were significantly increased in the PE group (19.2% vs. 3.3%, p < 0.001).

Conclusions

Patients with increased BMI, a history of deep venous thrombosis, and multivisceral resections are a high-risk group for PE after pancreatic surgery. While the absolute incidence and related mortality of PE after pancreatic surgery is low, it is associated with severe sequelae.

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Author notes

  1. Benjamin Müssle and Nathalie Buck contributed equally to this work.

Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, P.O. Box 01307, Dresden, Germany

    Benjamin Müssle, Nathalie Buck, Stephanie Schade, Marian Sommer, Florian Oehme, Andreas Bogner, Sebastian Hempel, Christoph Kahlert, Marius Distler, Jürgen Weitz & Thilo Welsch

  2. Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, P.O. Box 01307, Dresden, Germany

    Christoph Radosa

Authors
  1. Benjamin Müssle
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  2. Nathalie Buck
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  3. Stephanie Schade
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  4. Marian Sommer
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  5. Florian Oehme
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  6. Andreas Bogner
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  7. Sebastian Hempel
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  10. Marius Distler
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  11. Jürgen Weitz
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  12. Thilo Welsch
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Contributions

Study conception and design: TW, BM, JW. Acquisition of data: BM, NB, SS, MS, FO, AB, SH, CR. Analysis and interpretation of data: BM, NB, FO, CR, CK, TW, MD, JW. Drafting of the manuscript: BM, NB, CK, MD, JW, TW. Critical revision of the manuscript: TW, MD, JW

Corresponding author

Correspondence to Thilo Welsch.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board at the Technische Universität Dresden (decision number: EK295072017).

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The authors declare that they have no conflict of interest.

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Müssle, B., Buck, N., Schade, S. et al. Impact of pulmonary embolism on morbidity and mortality in patients undergoing pancreatic surgery. Langenbecks Arch Surg 406, 893–902 (2021). https://doi.org/10.1007/s00423-020-02009-4

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  • DOI: https://doi.org/10.1007/s00423-020-02009-4

Keywords

  • Pulmonary embolism
  • Deep venous thrombosis
  • Venous thromboembolism
  • Pancreatic surgery