Impact of Preoperative Factors of Dialysis Patients Who Underwent Pancreaticoduodenectomy on Postoperative Complications, 30-Day and Operative Mortality: Analysis Using the Japanese National Clinical Database.

BACKGROUND

Pancreaticoduodenectomy (PD) in dialysis patients is rare but carries a high risk of complications and mortality. This study aimed to identify preoperative factors associated with severe postoperative complications and mortality.

METHODS

Using the Japanese National Clinical Database, 329 dialysis patients undergoing PD between 2016 and 2020 were retrospectively analyzed. Multivariable penalized logistic regression identified preoperative risk factors for Clavien-Dindo classification (CDC) grade ≥ 4 complications, 30-day mortality, operative mortality, postoperative sepsis, and postoperative pancreatic fistula (POPF) (grade B or C).

RESULTS

CDC grade ≥ 4 complications, 30-day mortality, and operative mortality occurred in 10.3%, 5.5%, and 11.2%, respectively. Diet- or oral medication-treated diabetes (Odds ratio 5.19, 95% confidence interval 1.19-22.66) and insulin-treated diabetes (7.50, 1.61-34.93) independently predicted 30-day mortality. Serum albumin levels < 3.0 g/dL independently predicted operative mortality (2.72, 1.05-7.02), while cardiovascular disease showed a borderline association (2.15, 0.95-4.85). Elevated CRP was significantly associated with postoperative sepsis (2.47, 1.07-5.67), and pancreatic cancer was associated with a lower risk of POPF (grade B or C) (0.59, 0.37-0.94).

CONCLUSIONS

Dialysis patients undergoing PD face perioperative risks. Early mortality is driven by acute metabolic and infectious vulnerability, whereas operative mortality reflects diminished physiologic reserve related to malnutrition and cardiovascular comorbidity.