Hyperamylasemia and pancreatitis following posterior spinal surgery
Kazuyoshi Kobayashi1, Shiro Imagama2, Zenya Ito1
1Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
Background:
Postoperative pancreatitis has primarily been reported as a complication of abdominal surgery, but there are some case reports of postoperative pancreatitis after spinal surgery. The objective of this study was to investigate a case series of hyperamylasemia and pancreatitis following posterior spinal surgery.
Methods:
The serum amylase level was measured following posterior spinal surgery in the prone position. Patients were divided into groups with a normal serum amylase level (0-125 IU/L) and with hyperamylasemia (>125 IU/L), based on the upper limit of normal of 125 IU/L in our institution. Relationships among preoperative factors, perioperative factors, and the serum amylase level were investigated.
Results:
Hyperamylasemia (serum amylase >125 IU/L) following posterior spinal surgery was found in 92 cases (35 %). Among perioperative factors, intraoperative estimated blood loss (EBL) and operating time were significantly higher in patients with high serum amylase than in patients with normal serum amylase (P < 0.01). In a multivariate regression model, intraoperative EBL (OR 1.001, 95 % CI 1.000-1.002; P = 0.001) and operation time (OR 1.006, 95 % CI 1.003-1.009; P = 0.006) were significantly associated with postoperative pancreatitis. Serum amylase levels of ≥ 5 times the upper limit of normal were found in six cases. Five of these cases were asymptomatic and one was caused by severe pancreatitis.
Conclusions:
In our case series, intraoperative blood loss caused a rise in the serum amylase level following posterior spinal surgery. Thus, this level should be carefully monitored after spinal surgery with significant blood loss. Clinical symptoms of pancreatitis, such as abdominal pain and vomiting, should also be monitored following spinal surgery.
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