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01-02-2019 | Original Scientific Report

Hypophosphatemia as a Predictor of Organ-Specific Complications Following Gastrointestinal Surgery: Analysis of 8034 Patients

Authors: Eran Sadot, Jian Zheng, Rami Srouji, Vivian E. Strong, Mithat Gönen, Vinod P. Balachandran, Michael I. D’Angelica, Peter J. Allen, Ronald P. DeMatteo, T. Peter Kingham, Yuman Fong, Martin R. Weiser, William R. Jarnagin

Published in: World Journal of Surgery | Issue 2/2019

Abstract

Background

Organ-specific complications (OSC) remain serious potential sequela of gastrointestinal surgery. Hypophosphatemia correlates with poor outcomes and may be a harbinger of OSC after gastrointestinal surgery. Our goal was to describe and evaluate the relationship between postoperative phosphate levels and OSC.

Methods

Consecutive patients who underwent pancreatic, colorectal, or gastric resections were analyzed. OSC were defined as those resulting from the failure of at least one anastomosis performed during the primary resection, manifesting as an anastomotic leak, fistula, and/or intra-abdominal abscess. Postoperative serum phosphate levels and other recognized OSC risk factors were compared among patients who did and did not develop OSC.

Results

A total of 8034 patients who underwent pancreatic (n = 397), colorectal (n = 5808), or gastric (n = 1829) resections were included in the study. In each resection group, the majority of patients experienced hypophosphatemia postresection with the nadir on postoperative day (POD) 2, and the subgroups that developed OSC exhibited lower phosphate levels on POD3–7. On multivariate analysis, lower phosphate level on POD3 remained significantly associated with OSC following pancreatic resection [median (interquartile range) mmol/L, 0.65 (0.53–0.76) vs. 0.71 (0.61–0.84), p = 0.045] and colorectal resection [0.71 (0.61–0.87) vs. 0.77 (0.65–0.94), p = 0.006], and lower phosphate level on POD4 remained associated with OSC following gastric resection [0.87 (0.74–1.03) vs. 0.96 (0.81–1.13), p = 0.049].

Conclusion

This study identified a consistent trajectory of serum phosphate levels following 3 different gastrointestinal operations and association between early postoperative phosphate levels and OSC. Persistent lower phosphate levels should raise the level of concern for evolving postoperative leak and may lead to earlier radiographic evaluation and treatment.

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Title: Hypophosphatemia as a Predictor of Organ-Specific Complications Following Gastrointestinal Surgery: Analysis of 8034 Patients
Authors: Eran Sadot
Jian Zheng
Rami Srouji
Vivian E. Strong
Mithat Gönen
Vinod P. Balachandran
Michael I. D’Angelica
Peter J. Allen
Ronald P. DeMatteo
T. Peter Kingham
Yuman Fong
Martin R. Weiser
William R. Jarnagin
Publication date: 01-02-2019
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 2/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4726-3

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Springer Medicine

Hypophosphatemia as a Predictor of Organ-Specific Complications Following Gastrointestinal Surgery: Analysis of 8034 Patients

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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