The effect of high intraoperative blood loss on pancreatic f
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According to a recent study in patients with high estimated blood loss patients experienced higher clinically relevant pancreatic fistula rates.

In total, 7,706 pancreatoduodenectomies performed at 18 international institutions composing the Pancreas Fistula Study Group were examined. High estimated blood loss (>700 mL) was defined as twice the median. Propensity score matching was employed to adjust for variables associated with high estimated blood loss and clinically relevant pancreatic fistula occurrence. The study was powered to detect a 33% clinically relevant pancreatic fistula increase in the high estimated blood loss group, with ? = 0.05 and ? = 0.2.

The propensity score model included 966 patients with high estimated blood loss and 966 patients with lower estimated blood loss; all covariate imbalances were solved.

--Patients with high estimated blood loss patients experienced higher clinically relevant pancreatic fistula rates, as well as higher severe complication rates, transfusions, reoperations, intensive care unit transfers, and 90-day mortality.

--High estimated blood loss was an independent predictor for clinically relevant pancreatic fistula, as were prophylactic Octreotide administration and soft pancreatic texture.

--Moreover, a second model including 1,126 pancreatoduodenectomies was derived including vascular resections as an additional confounder.

--On multivariable regression, high estimated blood loss was confirmed as an independent predictor for clinically relevant pancreatic fistula reduction, whereas vascular resection was not.

This study better establishes the relationship between estimated blood loss and outcomes after pancreatoduodenectomy. Despite inherent contributions to blood loss, its minimization is an actionable opportunity for clinically relevant pancreatic fistula reduction and performance optimization in pancreatoduodenectomy. Accordingly, practical insights are offered to achieve this goal.

Source: https://doi.org/10.1016/j.surg.2021.03.044
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