Perioperative factor XIII and viscoelastic measurements of open compared to minimal invasive major upper...

Acquired Factor XIII (FXIII) deficiency is prevalent in hospitalized or surgical patients, with FXIII activity <70% in over 20% of cases. A decrease in FXIII has been linked with postoperative bleeding, anastomotic insufficiency, and a greater likelihood of requiring reoperation. This study aims to identify patients at increased risk for postoperative complications by comparing open versus minimally invasive pancreatic and esophageal surgery.

This prospective, monocentric observational study was conducted at Heidelberg University Hospital (Germany). Inclusion criteria consisted of age ≥ 18 years, the ability to provide informed consent, and scheduled esophageal or pancreatic surgery. A coagulation panel was performed preoperatively, directly after surgery and on postoperative day (POD) 1, 2, 3, 4, 7, 10, and 13, along with repeated thromboelastography (ClotPro®) Tests.

Finally, 112 patients were enrolled (n = 77 open and n = 35 minimally invasive). FXIII activity showed a more pronounced decrease in the open surgery group until day 7; in both groups, the lowest FXIII activity occurred between days 4 and 7. There were no significant group differences in readmissions, reoperations, or severe perioperative complications according to the Clavien-Dindo classification.

Open surgery was associated with a significant decline in FXIII activity, with a nadir estimated to occur between POD 4 and 7. FXIII activity also remained significantly reduced until day 7 after surgery. Viscoelastic testing was not able to detect mild acquired FXIII deficiencies. The extent to which routine testing of FXIII activity should be performed prior to reoperation must be evaluated in further studies. German Clinical Trials Register (DRKS00028547, registration date: April 14, 2022).