Skip to main content

Advertisement

SpringerLink
Log in

Incidence, clinical features, and risk factors for acute pancreatitis following posterior instrumented fusion surgery for lumbar degenerative disease: a single-center, retrospective analysis of 20,929 patients

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to identify the incidence, clinical features, and risk factors for postoperative acute pancreatitis (PAP) after lumbar surgery.

Methods

We retrospectively analyzed patients who developed PAP after posterior lumbar fusion surgery. For each PAP patient, data were collected for four controls who underwent procedures in the same period and did not develop PAP. Statistical methods included univariate and multivariate analyses.

Results

Totally, 21 out of 20,929 patients were diagnosed with PAP (0.10%) after posterior lumbar fusion surgery. Patients with degenerative lumbar scoliosis were at higher risk of developing PAP (P < 0.05). With atypical clinical features, PAP occurred within 3 days (0–5) after surgery. PAP patients had significantly higher incidence of osteoporosis (47.6 vs. 22.6%, P = 0.030) and fusion of L1/2(42.9 vs. 4.3%, P = 0.010), lower albumin (42.2 ± 4.1 vs. 44.3 ± 3.2 g/L, P = 0.010), more fusion segments (median 4 vs. 3, P = 0.022), larger surgical invasiveness index (median 9 vs. 8, P = 0.007), longer operation duration (232 ± 109 vs. 185 ± 90 min, P = 0.041), greater estimated blood loss (median 600 vs. 400 mL, P = 0.025), lower intraoperative mean arterial pressure (87.2 ± 9.9 vs. 92.1 ± 8.8 mmHg, P = 0.024). Multivariate logistic regression analysis found three independent risk factors: fusion of L1/2, surgical invasiveness index > 8, and intraoperative mean arterial pressure < 90 mmHg. All patients were treated with conservative therapy and fully recovered after 8.1 (4–22) days.

Conclusion

The incidence of PAP following posterior surgery for degenerative lumbar disease was 0.10%, and its clinical features were not typical. The fusion of L1/2, high surgical invasiveness index, and low intraoperative mean arterial pressure were independent risk factors for PAP after surgery for lumbar degenerative disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Lyu Y, Cheng Y, Li T et al (2019) Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc 33:3275–3286. https://doi.org/10.1007/s00464-018-06613-w

    Article  PubMed  Google Scholar 

  2. Marchegiani G, Barreto SG, Bannone E, et al. International Study Group for Pancreatic Surgery (2022) Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading From the International Study Group for Pancreatic Surgery (ISGPS). Ann Surg 275:663–672. https://doi.org/10.1097/SLA.0000000000005226

  3. Mangi AA, Christison-Lagay ER, Torchiana DF et al (2005) Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients. Ann Surg 241:895–904. https://doi.org/10.1097/01.sla.0000164173.05762.32

    Article  PubMed  PubMed Central  Google Scholar 

  4. Willems D, Hooghe L, Kinnaert P et al (1988) Postoperative pancreatitis, hyperamylasemia and amylase isoenzymes after parathyroidectomy for primary hyperparathyroidism. Gastroenterol Clin Biol 12:347–353 (PMID: 2454865)

    CAS  PubMed  Google Scholar 

  5. De la Garza RR, Goodwin CR, Abu-Bonsrah N et al (2016) Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample. J Neurosurg Pediatr 25:730–736. https://doi.org/10.3171/2016.6.PEDS16200

    Article  Google Scholar 

  6. Laplaza FJ, Widmann RF, Fealy S et al (2002) Pancreatitis after surgery in adolescent idiopathic scoliosis: incidence and risk factors. J Pediatr Orthop 22:80–83 (PMID: 11744859)

    Article  PubMed  Google Scholar 

  7. Curtin WA, Lahoti OP, Fogarty EE et al (1993) Pancreatitis after alar-transverse fusion for spondylolisthesis. A case report. Clin Orthop Relat Res 292:142–143 (PMID: 8519102)

    Article  Google Scholar 

  8. He Z, Tonb DJ, Dabney KW et al (2004) Cytokine release, pancreatic injury, and risk of acute pancreatitis after spinal fusion surgery. Dig Dis Sci 49:143–149. https://doi.org/10.1023/b:ddas.0000011616.79909.3c

    Article  PubMed  Google Scholar 

  9. El Bouyousfi M, Leveque C, Miladi L et al (2016) Acute pancreatitis following scoliosis surgery: description and clinical course in 14 adolescents. Eur Spine J 25:3316–3323. https://doi.org/10.1007/s00586-016-4595-0

    Article  PubMed  Google Scholar 

  10. Abousamra O, Nishnianidze T, Rogers KJ et al (2018) Risk factors for pancreatitis after posterior spinal fusion in children with cerebral palsy. J Pediatr Orthop B 27:163–167. https://doi.org/10.1097/BPB.0000000000000376

    Article  PubMed  Google Scholar 

  11. Borkhuu B, Nagaraju D, Miller F et al (2009) Prevalence and risk factors in postoperative pancreatitis after spine fusion in patients with cerebral palsy. J Pediatr Orthop 29:256–262. https://doi.org/10.1097/BPO.0b013e31819bcf0a

    Article  PubMed  Google Scholar 

  12. Juricic M Jr, Pinnagoda K, Lakhal W et al (2018) Pancreatic fracture: a rare complication following scoliosis surgery. Eur Spine J 27:2095–2099. https://doi.org/10.1007/s00586-017-5318-x

    Article  PubMed  Google Scholar 

  13. Rajaraman V, Heary RF, Livingston DH (2000) Acute pancreatitis complicating anterior lumbar interbody fusion. Eur Spine J 9:171–173. https://doi.org/10.1007/s005860050230

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Tauchi R, Imagama S, Ito Z et al (2014) Acute pancreatitis after spine surgery: a case report and review of literature. Eur J Orthop Surg Traumatol 1:S305–S309. https://doi.org/10.1007/s00590-013-1390-z

    Article  Google Scholar 

  15. Ravindra VM, Senglaub SS, Rattani A et al (2018) Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Global Spine J 8:784–794. https://doi.org/10.1177/2192568218770769

    Article  PubMed  PubMed Central  Google Scholar 

  16. Banks PA, Bollen TL, Dervenis C, et al. Acute Pancreatitis Classification Working Group (2013). Classification of acute pancreatitis - 2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111. https://doi.org/10.1136/gutjnl-2012-302779

  17. Mirza SK, Deyo RA, Heagerty PJ et al. (2008) Development of an index to characterize the "invasiveness" of spine surgery: validation by comparison to blood loss and operative time. Spine (Phila Pa 1976) 33:2651–2662. https://doi.org/10.1097/BRS.0b013e31818dad07

  18. Crockett SD, Wani S, Gardner TB, Committee AGAICG et al (2018) American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology 154:1096–1101. https://doi.org/10.1053/j.gastro.2018.01.032

    Article  PubMed  Google Scholar 

  19. Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association (2021) Guidelines for diagnosis and treatment of acute pancreatitis in China (2021). Zhonghua Wai Ke Za Zhi 59:578–587. https://doi.org/10.3760/cma.j.cn112139-20210416-00172

  20. Leichtner AM, Banta JV, Etienne N et al (1991) Pancreatitis following scoliosis surgery in children and young adults. J Pediatr Orthop 11:594–598 (PMID: 1717507)

    Article  CAS  PubMed  Google Scholar 

  21. Verhofste BP, Berry JG, Miller PE et al (2021) Risk factors for gastrointestinal complications after spinal fusion in children with cerebral palsy. Spine Deform 9:567–578. https://doi.org/10.1007/s43390-020-00233-y

    Article  PubMed  Google Scholar 

  22. Iinuma M, Akazawa T, Torii Y et al (2021) Increase in pancreatic enzymes following spinal alignment changes in the thoracolumbar junction: potential for acute pancreatitis after kyphosis correction. J Orthop Sci 26:528–532. https://doi.org/10.1016/j.jos.2020.05.009

    Article  PubMed  Google Scholar 

  23. Jayasinghe R, Ranasinghe S, Kuruppu C et al (2022) Clinical characteristics and outcomes of acute pancreatitis following spinal surgery: a systematic review. J Int Med Res 50:3000605221121950. https://doi.org/10.1177/03000605221121950

    Article  PubMed  Google Scholar 

  24. Rathod T, Sathe A, Mohanty SS et al (2020) Learning from mistakes: pancreatic laceration: devastating complication during spine surgery. World Neurosurg 141:81–84. https://doi.org/10.1016/j.wneu.2020.05.261

    Article  PubMed  Google Scholar 

  25. Feng F, Tan H, Li X et al. (2018) Incidence and risk factors of acute pancreatitis after scoliosis surgery: a prospective study. Spine (Phila Pa 1976) 43:630–636. https://doi.org/10.1097/BRS.0000000000002389

  26. Hackert T, Hartwig W, Fritz S et al (2009) Ischemic acute pancreatitis: clinical features of 11 patients and review of the literature. Am J Surg 197:450–454. https://doi.org/10.1016/j.amjsurg.2008.04.011

    Article  PubMed  Google Scholar 

  27. Holzer EM, Aghayev E, O’Riordan D et al (2021) Validation of a surgical invasiveness index in patients with lumbar spinal disorders registered in the Spine Tango registry. Eur Spine J 30:1–12. https://doi.org/10.1007/s00586-020-06651-w

    Article  PubMed  Google Scholar 

  28. Kumar N, Ramos MRD, Patel R et al. (2021) The "Spinal Metastasis Invasiveness Index": a novel scoring system to assess surgical invasiveness. Spine (Phila Pa 1976) 46:478–485. https://doi.org/10.1097/BRS.0000000000003823

  29. Zou D, Jiang S, Zhou S et al. (2020) Prevalence of osteoporosis in patients undergoing lumbar fusion for lumbar degenerative diseases: a combination of DXA and Hounsfield Units. Spine (Phila Pa 1976) 45:E406–E410. https://doi.org/10.1097/BRS.0000000000003284

  30. Korovessis PG, Stamatakis M, Baikousis A (1996) Relapsing pancreatitis after combined anterior and posterior instrumentation for neuropathic scoliosis. J Spinal Disord 9:347–350 (PMID: 8877965)

    Article  CAS  PubMed  Google Scholar 

  31. Gardner TB (2021) Acute Pancreatitis. Ann Intern Med 174:ITC17–ITC32. https://doi.org/10.7326/AITC202102160

Download references

Acknowledgements

Not applicable.

Funding

This work was supported by the National Natural Science Foundation of China (82172065) and the Peking University Third Hospital Clinical Chort Project (BYSYDL2021011).

Author information

Author notes

  1. Yuanyu Hu, Yanlei Dong and Zhongwei Yang are contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China

    Yuanyu Hu, Yanlei Dong, Zhongwei Yang, Junbo Qi, Guojin Hou, Yang Lv & Yun Tian

  2. Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing, 100191, China

    Yuanyu Hu, Yanlei Dong, Zhongwei Yang, Junbo Qi, Guojin Hou, Yang Lv & Yun Tian

  3. Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing, 100191, China

    Yuanyu Hu, Yanlei Dong, Zhongwei Yang, Junbo Qi, Guojin Hou, Yang Lv & Yun Tian

  4. Information Management and Big Data Center, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China

    Xin Zhang

Authors
  1. Yuanyu Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yanlei Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhongwei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Junbo Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guojin Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yang Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yun Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization was carried out by YL and YT; methodology by YH and Y.; formal analysis by ZY and YD; investigation by YH, JQ, and XZ; resources by GH, YL, and YT; data curation by YH, and YD; writing—original draft preparation—by YH, YD, and ZY; writing—review and editing—by YL and YT; project administration by YL and YT; funding acquisition by YT. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Yang Lv or Yun Tian.

Ethics declarations

Conflicts of interest

The authors have no further conflicts of interest to report.

Ethics approval

The study protocol was approved by the Medical Science Research Ethical Committee of Peking University Third Hospital (Ethics No.: M2022097). For this type of study, formal consent is not required. 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. As for the typical case presented in Figs. 3 and 4, the patient and his family allowed us to submit his data for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hu, Y., Dong, Y., Yang, Z. et al. Incidence, clinical features, and risk factors for acute pancreatitis following posterior instrumented fusion surgery for lumbar degenerative disease: a single-center, retrospective analysis of 20,929 patients. Eur Spine J 32, 3218–3229 (2023). https://doi.org/10.1007/s00586-023-07845-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07845-8

Keywords

Search

Navigation