Risk Factors And Management Of Delayed Hemorrhage After Pancreaticoduodenectomy:Analysis Of 1099 Consecutive Patients

Objective: Delayed hemorrhage is one of the most serious complications after pancreaticoduodenectomy.The aim of this study was to identify risk factors of delayed hemorrhage and to explore appropriate therapeutic modalities.Methods: Between 2012 and 2018,1099 patients underwent pancreasticoduodenectomy were included in this study,their clinical data were extracted from our electric database and analyzed retrospectively.Delayed hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria.Results: Overall incidence of postoperative hemorrhage was 8.8%(97 of 1099 pancreaticoduodenectomies)and the incidence of delayed hemorrhage was 6.6%(73 of 1099).32 of 73 patients had mild delayed hemorrhage(ISGPS grade B),while 41 patients had severe delayed hemorrhage(ISGPS grade C).Overall mortality was 4.64%(51 of 1099),the mortality of delayed hemorrhage was 38.26%(28 of 73 patients).Multivariate analysis found male gender,postoperative pancreatic fistula(POPF),postoperative bile leakage and postoperative abdominal infection were the independent risk factors for delayed hemorrhage after pancreaticoduodenectomy.Conclusion: Delayed hemorrhage remains to be one of the most lethal complication after pancasticoduodenectomy.The occurrence of delayed hemorrhage is highly related to postoperative complications such as POPF and abdominal infection.Male gender is also found to be the independent risk factor of delayed hemorrhage,but there is no sensible explanation for this phenomenon.