Preoperative heart disease and risk for postoperative complications after pancreatoduodenectomy

Area of Science:

• Cardiovascular Surgery
• Gastrointestinal Surgery
• Surgical Outcomes Research

Background:

• Comorbidities, particularly heart disease, are known risk factors for postoperative complications following major surgeries.
• The specific impact of different heart disease subtypes on outcomes after pancreatoduodenectomy remains under-investigated.

Purpose of the Study:

• To investigate the association between pre-existing heart disease and postoperative outcomes in patients undergoing pancreatoduodenectomy.
• To differentiate the risks associated with specific categories of heart disease: ischemic, valvular, heart failure, and atrial fibrillation.

Main Methods:

• A retrospective cohort study included 971 adult patients who underwent pancreatoduodenectomy between 2008 and 2019.
• Heart disease was categorized preoperatively. Postoperative outcomes, including complication severity (Clavien-Dindo score), intensive care unit (ICU) admission, hospitalization duration, and mortality, were analyzed using multivariable regression.

Main Results:

• 23.3% of patients had pre-existing heart disease, which was linked to increased complications (Clavien-Dindo score ≥ IIIa), higher ICU admission rates, and longer hospital stays.
• While heart disease did not significantly increase 90-day mortality, it was associated with a shorter overall survival.
• Atrial fibrillation and heart failure were independently associated with higher complication risks, unlike ischemic or valvular heart disease.

Conclusions:

• Atrial fibrillation and heart failure are significant independent predictors of increased postoperative complications after pancreatoduodenectomy.
• Pre-existing heart disease, particularly heart failure and atrial fibrillation, negatively impacts long-term survival despite not affecting early mortality.