SAN FRANCISCO – A patient body temperature higher than 99.5° F (37.5° C) at the end of elective pancreaticoduodenectomy predicted a fourfold increased risk of postoperative pancreatic fistula in a retrospective study of 123 patients.
Two factors independently predicted a significantly increased risk for postoperative pancreatic fistula in a multivariate logistic regression analysis – body temperature at the end of surgery and a soft pancreatic texture (which conferred a 34-fold increase in risk), Dr. Tadashi Tanioku and his associates.
It wasn’t clear whether pancreatic fistula caused the intraoperative elevated body temperature or the hyperthermia contributed to postoperative development of fistula, but the findings suggest that body temperature at the conclusion of surgery may provide a clue to a patient’s risk of postoperative pancreatic fistula, said Dr. Tanioku of Wakayama (Japan) Medical University.
The study included all patients who underwent pancreaticoduodenectomy for benign or malignant diseases in the pancreatic head and the periampullary region during a 2-year period at his hospital. Thirty-six percent developed postoperative pancreatic fistulas, the investigators reported in a poster presentation at the annual meeting of the American Society of Anesthesiologists.
In a univariate logistic regression analysis, significant predictors for postoperative pancreatic fistula included a body temperature higher than 99.5 degrees Fahrenheit in 45% of patients, soft pancreatic texture in 52%, and a pancreatic duct diameter less than 3 mm in 43% of patients. Having a body mass index greater than 25 kg/m2 (in 17% of patients) was not a significant predictor).
Previous studies have reported an association between hyperthermia on postoperative day 3 after pancreaticoduodenectomy and the development of postoperative pancreatic fistula. Other data have shown an association between intraoperative hyperthermia during colorectal surgery and increased risk of postoperative anastomotic leakage.
In general, operative mortality after pancreaticoduodenectomy had declined to less than 5% but postoperative morality rates are still 40%-50%, mainly from postoperative pancreatic fistula, Dr. Tanioku said.
Patients who developed pancreatic fistula were significantly younger than those who didn’t (a mean of 68 vs. 72 years, respectively) and were significantly more likely to have a main pancreatic duct diameter less than 3 mm (59% vs. 30%, respectively). Fifty-nine percent of patients who developed postoperative fistulas and 37% of those who didn’t had a body temperature higher than 99.5° F at the end of surgery. Eighty-six percent of patients who went on to develop fistulas and 29% of those who didn’t had a soft pancreatic texture.
Dr. Tanioku reported having no financial disclosures.
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