Frequency of lactate elevation following pancreatic surgery and its relationship to postoperative complications

Lactate is often elevated following major pancreatic surgery but the clinical relevance of this it not known.

A retrospective study including 491 consecutive patients undergoing major pancreatic surgery. Lactate upon arrival to post anaesthesia unit (L₀), the morning following surgery (L_POD1) and the highest value within those two time points (L_High) were examined. The primary outcome was postoperative complications (Clavien-Dindo IIIa-V) and the secondary outcomes were surgery specific complications and hospital length of stay.

Median lactate values were: L01.7 mmol/L (IQR: 1.2 -2.6), LPOD11.3 mmol/L (IQR: 0.9 -1.9) and L_High 2.3 mmol/L (IQR 1.7 -3.1). There were no differences in lactate values at any measuring point between those developing complications and those that didn´t. AUROC analysis (0.531-0.581) and Youden´s index (0.08-0.17) indicated poor diagnostic performance. L_High > 2.65 mmol/L was associated with Odds ratio 2.05 (1.34 -3.14) for developing postoperative complications. Plasma lactate was higher following total pancreatectomy compared to partial resection at all three time points.

Plasma lactate elevation in common following pancreatic surgery; however, this is of limited clinical use to predict complications. The relatively higher lactate following total pancreatectomy might be due to hormonal deficits inherent to this procedure.