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POST-PANCREATECTOMY ACUTE PANCREATITIS: A FIRST NATIONAL DATABASE PERSPECTIVE
Andrew J. Thyen
*, Thomas K. Maatman, Alex M. Roch, Ryan J. Ellis, Eugene Ceppa, Michael G. House, Max Schmidt, Nicholas J. Zyromski
General Surgery, Indiana University School of Medicine, Indianapolis, IN
Background: Post-pancreatectomy acute pancreatitis (PPAP) is common but underrecognized; formally defined by the ISGPS in 2022 as a 48 hour postoperative elevation of serum amylase
and radiographic confirmation of pancreatitis. PPAP is graded as postoperative hyperamylasemia (POH), Grade B, and Grade C. Research regarding PPAP is limited to single institution studies with limited sample size. The recently released 2023 National Surgical Quality Improvement Program’s (NSQIP) pancreatectomy targeted participant use file (PUF) included for the first time PPAP variables. We hypothesized that these data will reflect the incidence of PPAP in a national sample.
Methods: Patients who underwent a pancreatectomy at the 168 participating institutions between January 1
st and December 31
st 2023 were included in the pancreatectomy targeted dataset. Cases were identified and included via CPT codes; variables were captured through retrospective review by trained surgical clinical reviewers. Data were amassed and managed by the American College of Surgeons NSQIP. Data were analyzed with SPSS (IBM, Chicago, IL).
Results: A total of 8,015 pancreatectomies were reported in the 2023 targeted dataset (Figure 1). Forty-eight hours of elevated serum amylase was reported in 1,325 (17%) patients. Median amylase was 296 (IQR 161-594). 517 (39%) of the 1,325 patients had a recorded serum amylase >100 U/L. Among the 517 patients with elevated serum amylase, 457 (88%) had POH. Among these 457 patients with an elevated serum amylase, 60 (12%) had CT scans within 14 days of the operation. Those who had a CT scan (therefore fulfilling ISGPS definition), 52 (87%) had a final grading of Grade B and 8 (13%) Grade C PPAP.
Conclusions: These data provide for the first time a national sample of PPAP. The overall incidence of POH and PPAP from the available data is 39%, with 13% of this amount being grade B or C PPAP. The finding that 85% of pancreatectomy patients did not have serum amylase drawn highlights significant room to improve practice by daily measurement of serum amylase in pancreatectomy patients.
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