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Hypertension Requiring Medication Use: a Silent Predictor of Poor Outcomes After Pancreaticoduodenectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Although hypertension requiring medication (HTNm) is a well-known cardiovascular comorbidity, its association with postoperative outcomes is understudied. This study aimed to evaluate whether preoperative HTNm is independently associated with specific complications after pancreaticoduodenectomy.

Study Design

Adults undergoing elective pancreaticoduodenectomy were included from the 2014–2019 NSQIP-targeted pancreatectomy dataset. Multivariable regression models compared outcomes between patients with and without HTNm. Endpoints included significant complications, any complication, unplanned readmissions, length of stay (LOS), clinically relevant postoperative pancreatic fistula (CR-POPF), and cardiovascular and renal complications. A subgroup analysis excluded patients with diabetes, heart failure, chronic obstructive pulmonary disease, estimated glomerular filtration rate from serum creatinine (eGFRCr) < 60 ml/min per 1.73 m2, bleeding disorder, or steroid use.

Results

Among 14,806 patients, 52% had HTNm. HTNm was more common among older male patients with obesity, diabetes, congestive heart failure, chronic obstructive pulmonary disease, functional dependency, hard pancreatic glands, and cancer. After adjusting for demographics, preoperative comorbidities, and laboratory values, HTNm was independently associated with higher odds of significant complications (aOR 1.12, p = 0.020), any complication (aOR 1.11, p = 0.030), cardiovascular (aOR 1.78, p = 0.002) and renal (aOR 1.60, p = 0.020) complications, and unplanned readmissions (aOR 1.14, p = 0.040). In a subgroup analysis of patients without major preoperative comorbidity, HTNm remained associated with higher odds of significant complications (aOR 1.14, p = 0.030) and cardiovascular complications (aOR 1.76, p = 0.033).

Conclusions

HTNm is independently associated with cardiovascular and renal complications after pancreaticoduodenectomy and may need to be considered in preoperative risk stratification. Future studies are necessary to explore associations among underlying hypertension, specific antihypertensive medications, and postoperative outcomes to investigate potential risk mitigation strategies.

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Data Availability

The data that support the findings of this study is hosted by the American College of Surgeons on the ACS NSQIP Registry, available at https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/.

Abbreviations

HTNm:

Hypertension requiring medication

ACS:

American College of Surgeons

NSQIP:

National Surgical Quality Improvement Program

CR-POPF:

Clinically relevant postoperative pancreatic fistula

eGFRCr:

Estimated glomerular filtration rate from serum creatinine

PE:

Pulmonary embolism

DVT:

Deep vein thrombosis

LOS:

Length of stay

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary disease

ACE-I:

Angiotensin-converting enzyme inhibitors

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Funding

P.C.C. was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, UCSF-CTSI Grant Number TL1 TR001871, and the National Cancer Institute, National Institutes of Health, Grant Number T32CA25107001. M.Y. is funded by the National Clinician Scholars Program.

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Authors and Affiliations

  1. School of Medicine, University of California, San Francisco, San Francisco, USA

    Jackie J. Lin

  2. Department of Surgery, University of California, San Francisco, San Francisco, USA

    Patricia C. Conroy, Fernanda Romero-Hernandez & Mignote Yilma

  3. National Clinician Scholars Program, University of California, San Francisco, San Francisco, USA

    Mignote Yilma

  4. Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, USA

    Jean Feng

  5. Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA

    Kenzo Hirose, Eric Nakakura, Ajay V. Maker, Carlos Corvera, Kimberly Kirkwood, Adnan Alseidi & Mohamed A. Adam

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Contributions

All authors listed have contributed substantially to this work, from conceptualization and design to analysis and interpretation of the data. All authors were involved in either drafting or critically revising the manuscript. Statistical analysis was performed by J. Lin under the supervision of P. Conroy, J. Feng, and M. Adam.

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Correspondence to Mohamed A. Adam.

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These contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

This work was accepted for oral presentation at the Scientific Forum of the American College of Surgeons Clinical Congress 2022, to be held in San Diego, CA, from October 16 to 20, 2022.

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Lin, J.J., Conroy, P.C., Romero-Hernandez, F. et al. Hypertension Requiring Medication Use: a Silent Predictor of Poor Outcomes After Pancreaticoduodenectomy. J Gastrointest Surg 27, 328–336 (2023). https://doi.org/10.1007/s11605-022-05577-6

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