1. Early postoperative serum hyperamylasemia: Harbinger of morbidity hiding in plain sight?
- Author
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McGuire SP, Maatman TK, Keller SL, Ceppa EP, House MG, Nakeeb A, Nguyen TK, Schmidt CM, and Zyromski NJ
- Subjects
- Aged, Aged, 80 and over, Amylases blood, Female, Hospital Mortality, Humans, Hyperamylasemia blood, Hyperamylasemia diagnosis, Hyperamylasemia etiology, Lipase blood, Male, Middle Aged, Pancreatic Fistula blood, Pancreatic Fistula diagnosis, Pancreatic Fistula etiology, Pancreatitis blood, Pancreatitis diagnosis, Pancreatitis etiology, Postoperative Complications blood, Postoperative Complications diagnosis, Postoperative Complications etiology, Prospective Studies, Retrospective Studies, Hyperamylasemia epidemiology, Pancreatic Fistula epidemiology, Pancreaticoduodenectomy adverse effects, Pancreatitis epidemiology, Postoperative Complications epidemiology
- Abstract
Background: The clinical significance of postoperative serum pancreatic enzyme elevation after pancreatoduodenectomy is understudied. We hypothesized that elevation in serum enzymes predicts morbidity and mortality after pancreatoduodenectomy., Methods: Retrospective review of 677 patients who underwent pancreatoduodenectomy at a single institution from 2013 to 2019. Patients were categorized based on serum enzyme concentrations. Patient characteristics, drain amylase, and outcomes among groups were compared., Results: In total, 415 of 677 patients had postoperative serum amylase concentrations measured. Of these, 243 (59%) were normal, 96 (23%) were classified as postoperative serum hyperamylasemia, and 76 (18%) were classified as postoperative acute pancreatitis. Major morbidity was lower among patients with normal enzyme concentration (10%) and higher in patients with postoperative serum hyperamylasemia (23%) and postoperative acute pancreatitis (18%) (P = .008). Patients with normal enzymes were less likely to develop postoperative pancreatic fistula (5%) compared with patients with postoperative serum hyperamylasemia (26%) and postoperative acute pancreatitis (21%) (P < .001) and less likely to develop delayed gastric emptying (9% vs 23% and 20%, respectively); P = .002. No difference in mortality was seen among groups., Conclusion: Elevated serum pancreatic enzyme concentration occurs frequently after pancreatoduodenectomy and is associated with increased postoperative morbidity. Serum enzyme concentration should be considered in management after pancreatoduodenectomy., (Copyright © 2021. Published by Elsevier Inc.)
- Published
- 2022
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