EFFECTS OF PERFUSION PRESSURE AND VASOPRESSORS ON THE RISK OF POSTOPERATIVE COMPLICATIONS IN PANCREATICODUODENECTOMY
DOI:
https://doi.org/10.11603/2414-4533.2024.2.14851Keywords:
pancreaticoduodenectomy, postoperative complications, pancreatic fistulas, perfusion pressure, vasopressors, norepinephrineAbstract
The aim of the work: To investigate the effect of perfusion pressure and the use of vasopressors on the incidence of postoperative pancreatic fistula (POPF) and other complications in patients after pancreaticoduodenectomy. Since POPF is one of the most serious complications requiring long-term treatment and can lead to increased mortality, knowledge of the risk factors for its occurrence is critical for optimizing postoperative management.
Materials and Methods: The analysis included 234 patients who underwent pancreaticoduodenectomy during 2022-2023. The study was based on a retrospective review of data collected at the O.O. Shalimov National Research Center of Surgery and Transplantation. Perfusion pressure, use of vasopressors, duration of surgery, texture of the pancreatic stump, and use of prophylactic antibiotic therapy were studied.
Results and Discussion: In our study of 234 patients (150 males and 84 females) with a mean age of 68 years, we found that pancreatic fistulas (PF) occurred in 44 patients (18.8 %), of which 27 cases were classified as grade B (61.36 %) and 17 cases as grade C (38.64 %) according to the ISGPS classification. The average duration of the operation was about 356 minutes. The analysis showed that a decrease in perfusion pressure by 1 mm Hg significantly (p<0.05) increased the risk of POPF by 158 %. At the same time, the dosage of the vasopressor norepinephrine did not demonstrate a statistically significant effect on the risk of PAH (p>0.05), which indicates that vasopressors can be safely used to correct hypotension without increasing the risk of complications.
Statistical analysis revealed a significant difference in mean perfusion pressure between the groups with and without POPF, where the group without POPF had a higher mean perfusion pressure (71.15 mm Hg) compared to the group with POPF (66.55 mm Hg) with a p-value of approximately 6.91×10-7. The duration of surgery was also significantly different, being longer in cases with POPF (391.05 minutes) compared to cases without POPF (348.01 minutes), with a p-value of 0.0057. However, the average blood loss, although higher in the group with POPF, did not reach statistical significance (p=0.0554), indicating that there was no significant difference in this indicator.
According to the results of ROC analysis, it was determined that perfusion pressure below 69.35 mm Hg is associated with a significant increase in the risk of POPF, which may serve as a threshold for identifying high-risk patients and implementing appropriate preventive measures. The area under the ROC curve (AUC) is approximately 0.76, which confirms the good diagnostic ability of the model to distinguish cases with POPF from those without POPF.
These results emphasize the importance of perfusion pressure monitoring as a critical factor in preventing the development of POPF after pancreaticoduodenectomy, as well as the importance of additional studies to optimize the use of vasopressors in this patient population.
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