Impact of postoperative hyperamylasemia and post-pancreatectomy acute pancreatitis following pancreaticoduodenectomy in a single-center cohort.

BACKGROUND

The clinical significance of postoperative hyperamylasemia (POH) and post-pancreatectomy acute pancreatitis (PPAP) following pancreaticoduodenectomy (PD) is understudied. Hence, we aimed to determine the incidence, risk factors, and short-term clinical impact of post-PD POH and PPAP.

METHODS

A retrospective, single-center, observational study was conducted with consecutive adult patients who underwent surgery between January 2012 and September 2025. POH and PPAP were defined and graded using the 2022 International Study Group of Pancreatic Surgery (ISGPS) consensus criteria.

RESULTS

Among the 244 participants, 25.4% developed POH and 31.1% developed PPAP. Those with PPAP demonstrated significantly higher rates of clinically relevant postoperative pancreatic fistula (CR-POPF), postoperative complications (Clavien-Dindo classification ≥3), and longer hospital and intensive care unit (ICU) stays compared to those without PPAP. There was no difference in the 90-day mortality rate. Perioperative factors were significantly associated with PPAP in the univariate analysis, including male sex [odds ratio (OR) =1.83; 95% confidence interval (CI): 1.05-3.17; P=0.03] and the presence of preoperative biliary drainage (OR =1.84; 95% CI: 1.01-3.35; P=0.047). Two intraoperative characteristics were identified as significant risk factors for PPAP: soft pancreatic texture (OR =2.58; 95% CI: 1.39-4.81; P=0.003) and a narrower pancreatic duct (OR =0.77; 95% CI: 0.66-0.99; P=0.002). CR-POPF was associated with an increased incidence of PPAP (OR =11.13; 95% CI: 5.61-22.07; P=0.001). In the multivariate analysis, male sex (OR =2.49; 95% CI: 1.13-5.51; P=0.02) and CR-POPF (OR =17.55; 95% CI: 7.13-43.19; P<0.001) were identified as risk factors for PPAP.

CONCLUSIONS

PPAP is associated with an increased risk of adverse outcomes. It has potential as an indicator of surgical morbidity and of prolonged hospital and ICU stays.