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PREOPERATIVE WEIGHT LOSS: A DOUBLE-EDGED SWORD IN PREVENTING POSTOPERATIVE PANCREATIC FISTULA FORMATION
Jennifer Hwang
*, Emily Papai, James Sun, Jordan D. Fredette, Leonard Miller, Hal Rives, Joseph Krempa, Anthony Villano, Sanjay S. Reddy
Fox Chase Cancer Center, Philadelphia, PA
Introduction: Postoperative pancreatic fistula (POPF) is a dreaded complication after pancreatic resection. Despite advancements in surgical techniques, reported POPF rates have been high even in the hands of experienced surgeons at high-volume institutions. POPF is associated with longer hospitalization, higher readmissions, increased resource utilization, and early postoperative mortality. Preoperative weight loss (WL) has been identified as a significant predictor of adverse outcomes after gastrointestinal surgery. However, the association between preoperative WL and the development of POPF remains unclear. We aim to analyze the association between preoperative WL and the development of POPF.
Methods: The National Surgical Quality Improvement Program (NSQIP) database was retrospectively analyzed between 2014-2020. Patients with pancreatic resection and known fistula status were included then categorized into two groups, preoperative weight loss (WL) versus no preoperative weight loss (NWL). Weight loss was defined as >10% unintentional reduction in weight within 6 months prior to surgery.
Results: Of the 43,126 patients included in this study, 7,017 (16.3%) developed a POPF. Most patients were Caucasian (73.4%) males (50.7%) with malignant pathology (74.9%). Most patients did not receive neoadjuvant chemotherapy (80.7%) or neoadjuvant radiation (92.6%). Preoperative WL was not independently associated with POPF (p=0.389). There was a significant interaction between African American race and weight loss on the development of POPF. African Americans who experienced weight loss were more likely [odds ratio (OR)=1.17] to develop a fistula than Caucasians who experienced weight loss, while African Americans who did not experience weight loss were less likely (OR=0.76) to develop a fistula than Caucasians who did not experience weight loss (p=0.0012). There was also a significant interaction between weight loss and large duct size (>6 mm) on the development of a pancreatic fistula. Patients who experienced weight loss had 0.24 times the odds of developing a fistula compared to patients with a duct size < 3mm, while patients who did not experience weight loss had 0.50 times the odds of developing a fistula compared to patients with a duct size < 3mm (p=0.0021).
Conclusion: Preoperative WL is not independently associated with POPF formation. However, we found that the impact of preoperative WL on the development of POPF varies with race and duct size.
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