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The impact of perioperative inotropes on the incidence of pancreatic leak following pancreaticoduodenectomy
Ann Hepatobiliary Pancreat Surg 2019 Nov;23(4):392-6
Published online November 30, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Patrick Casey1, Madhu Parna Chaudhury1, Asaad Khan1, Jebran Amin1, Abdul Afzal1, Carmello Corallo1, Domnic Sebastian2, Matthew Atkinson2, and Daren Subar1

Departments of 1HPB Surgery, 2Anaesthesia, East Lancashire NHS Hospital Trust, Blackburn, UK
Received January 30, 2019; Revised July 18, 2019; Accepted July 25, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Pancreatic leak and fistula formation following pancreatic resection is a dreaded complication associated with significant morbidity and mortality. The perioperative use of inotropes has been implicated in anastomotic dehiscence in other types of gastrointestinal surgery but their impact in pancreatic surgery remains unclear and a potentially modifiable risk factor for pancreatic leak. This study aims to assess the impact of perioperative inotrope infusion on the incidence of pancreatic leak following pancreaticoduodenectomy.
Methods: Retrospective data analysis of all patients undergoing pancreaticoduodenectomy at a tertiary HPB institute. Multivariate analysis and regression models assessed the impact of inotrope use against other known risk factors such as pancreatic duct size and gland texture. Pancreatic fistulae were graded as per ISGPF as Grade A (biochemical leak), Grade B and Grade C fistula.
Results: One-hundred and twenty-three (123) patients were included. A total of 52 patients (42%) developed a leak (29 grade A, 15 grade B, and 8 Grade C). In the fistula group, 28 patients (55%) received perioperative inotropes compared to 26 (35%) in the no fistula group. On univariate analysis, patients receiving inotropes (p=0.04) and patients with a soft pancreatic texture (p=0.003) had a statistically higher incidence of developing a pancreatic fistula of any grade. On multivariate analysis, only inotrope use was associated with an increased risk of developing a pancreatic fistula of any grade (OR 2.46, p=0.026), independent of pancreatic texture and pancreatic duct size.
Conclusions: Perioperative inotrope use is associated with an increase incidence of pancreatic leak following pancreaticoduodenectomy and should therefore be used judiciously.
Keywords : Pancreatic fistula; Pancreaticodudenectomy; Inotropic agent; Pancreatic cancer


November 2019, 23 (4)