Postpancreatectomy acute pancreatitis: a United States national perspective

Postpancreatectomy acute pancreatitis (PPAP) is an increasingly recognized but still disputed clinical entity. Defined by the International Study Group for Pancreatic Surgery in 2022 as a 48-hour postoperative elevation of serum amylase level and radiographic confirmation of pancreatitis. PPAP is graded as postoperative hyperamylasemia (POH), grade B, and grade C. The 2023 National Surgical Quality Improvement Program's (NSQIP) pancreatectomy-targeted Participant Use Data File included for the first time PPAP variables. This study aimed to determine whether the NSQIP data will reflect the incidence of PPAP in a national sample.

Patients who underwent a pancreatectomy at 168 participating institutions between January 1, 2023, and December 31, 2023, were included in the NSQIP pancreatectomy-targeted dataset. Cases were identified using Current Procedural Terminology codes. The variables were captured retrospectively. Data were amassed and managed by the American College of Surgeons NSQIP.

Of 8015 patients included in the analysis, 1273 (17%) had amylase values. Among these patients, 782 (61%) had normal serum amylase level, 430 (34%) had POH, 53 (4.1%) had grade B PPAP, and 8 (0.01%) had grade C PPAP. Multivariable logistic regression found a small pancreatic duct and soft pancreatic texture to be significantly associated with POH and clinically relevant PPAP (CR-PPAP) for head resections. Patients with POH and CR-PPAP were significantly more likely to have any-cause morbidity and complications, such as Clavien-Dindo grade ≥ 3 (P <.05 and P <.05, respectively).

This is the first national survey of patients who underwent pancreatectomy that confirmed a high incidence of POH and PPAP. The low rate of amylase level measurement suggests that general education about this disease process will be important. Normal pancreatic texture is the most significant risk factor for developing POH/PPAP, and mitigation strategies and more liberal use of early postoperative imaging should be considered for patients.