Risk factors associated with postoperative pancreatic fistula in the elderly

Abstract

Background: Postoperative pancreatic fistula is the main cause of morbidity and mortality associated with pancreaticoduodenectomy. Few studies have evaluated these complications in the elderly.
Objective: The aim of the present study was to describe the risk factors associated with the development of pancreatic fistula in elderly patients undergoing pancreaticoduodenectomy.
Material and methods: We conducted a retrospective cohort study in a high-complexity institution between 2018 and 2023. The variables were presented as percentages and measures of central tendency and were compared using the chi-square test and the Mann-Whitney U test. A logistic regression analysis was performed to calculate the odds ratio (OR). The analysis was performed using Stata 15 software package.
Results: A total of 76 patients underwent pancreaticoduodenectomy; 11.84% presented pancreatic fistula, mostly men (77.78%) with a mean age of 64 years (65-68). Abdominal pain was the most common symptom (77.78%). There were no statistically significant differences among patients with and without fistulas for the variables sex (OR = 0.33; 95% CI: 0.19-1.72), diabetes (OR = 0.79; 95% CI: 0.76-3.49), body mass index (BMI in kg/m2; OR = 1.21; 95% CI: 0.1-1.51), pancreatic duct diameter (OR=1.62; 95% CI: 0.52-7.03), soft pancreatic gland texture (OR=3.2; 95% CI 0.17-16.55), length of hospital stay in days (OR=1.01; 95% CI: 0.49-1.05), and mortality (OR=1.75; 95% CI: 0.62-15.3).
Conclusion: Postoperative pancreatic fistula is a common complication in patients undergoing pancreaticoduodenectomy. Patients at higher risk for this complication should be identified preoperatively to establish measures to reduce its incidence.