title: Late postpancreatectomy hemorrhage after pancreaticoduodenectomy: is it possible to recognize risk factors?
abstract: BACKGROUND
  Post-pancreatectomy hemorrhage is one of the most common complications after pancreaticoduodenectomy.
  
  
  OBJECTIVE
  To evaluate the late post-pancreatectomy hemorrhage rate according to the International Study Group of Pancreatic Surgery criteria and to recognize factors related to its onset.
  
  
  METHODS
  A prospective study of 113 patients who underwent pancreaticoduodenectomy was conducted. Late post-pancreatectomy hemorrhage was defined according to the criteria of the International Study Group of Pancreatic Surgery. Demographic, clinical, surgical and pathological data were considered and related to late post-pancreatectomy hemorrhage.
  
  
  RESULTS
  Thirty-one (27.4%) patients had a post-pancreatectomy hemorrhage. Twenty-five (22.1%) patients developed late post-pancreatectomy hemorrhage: 19 (16.8%) grade B, 6 (5.3%) grade C. Surgical re-operation was performed in 2 out of the 25 cases with late post-pancreatectomy hemorrhage (8.0%) grade C associated with postoperative pancreatic fistula. At univariate analysis, the only factor significantly related to late post-pancreatectomy hemorrhage was postoperative pancreatic fistula (P<0.001). Multivariate analysis underlined that the severity of postoperative pancreatic fistula (P<0.001) and pancreatic anastomosis (P=0.049) independently increased the risk of late hemorrhage.
  
  
  CONCLUSIONS
  In patients undergoing pancreaticoduodenectomy, the criteria introduced by International Study Group of Pancreatic Surgery to define late postpancreatectomy hemorrhage are related to a higher incidence of hemorrhage than previously detected because they considered also mild hemorrhage.
authors.affiliation: Department of Surgical and Anesthesiological Sciences, Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ricci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Salvatore
authors.initials: S
authors.lastname: Buscemi
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000401:mortality / Q000601:surgery; D000368:Aged; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D010185:Pancreatic Fistula / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D050500:Pancreatitis, Chronic / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors