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09-01-2023 | Hypertension | Original Article

Hypertension Requiring Medication Use: a Silent Predictor of Poor Outcomes After Pancreaticoduodenectomy

Authors: Jackie J. Lin, Patricia C. Conroy, Fernanda Romero-Hernandez, Mignote Yilma, Jean Feng, Kenzo Hirose, Eric Nakakura, Ajay V. Maker, Carlos Corvera, Kimberly Kirkwood, Adnan Alseidi, Mohamed A. Adam

Published in: Journal of Gastrointestinal Surgery | Issue 2/2023

Abstract

Background

Although hypertension requiring medication (HTNm) is a well-known cardiovascular comorbidity, its association with postoperative outcomes is understudied. This study aimed to evaluate whether preoperative HTNm is independently associated with specific complications after pancreaticoduodenectomy.

Study Design

Adults undergoing elective pancreaticoduodenectomy were included from the 2014–2019 NSQIP-targeted pancreatectomy dataset. Multivariable regression models compared outcomes between patients with and without HTNm. Endpoints included significant complications, any complication, unplanned readmissions, length of stay (LOS), clinically relevant postoperative pancreatic fistula (CR-POPF), and cardiovascular and renal complications. A subgroup analysis excluded patients with diabetes, heart failure, chronic obstructive pulmonary disease, estimated glomerular filtration rate from serum creatinine (eGFRCr) < 60 ml/min per 1.73 m², bleeding disorder, or steroid use.

Results

Among 14,806 patients, 52% had HTNm. HTNm was more common among older male patients with obesity, diabetes, congestive heart failure, chronic obstructive pulmonary disease, functional dependency, hard pancreatic glands, and cancer. After adjusting for demographics, preoperative comorbidities, and laboratory values, HTNm was independently associated with higher odds of significant complications (aOR 1.12, p = 0.020), any complication (aOR 1.11, p = 0.030), cardiovascular (aOR 1.78, p = 0.002) and renal (aOR 1.60, p = 0.020) complications, and unplanned readmissions (aOR 1.14, p = 0.040). In a subgroup analysis of patients without major preoperative comorbidity, HTNm remained associated with higher odds of significant complications (aOR 1.14, p = 0.030) and cardiovascular complications (aOR 1.76, p = 0.033).

Conclusions

HTNm is independently associated with cardiovascular and renal complications after pancreaticoduodenectomy and may need to be considered in preoperative risk stratification. Future studies are necessary to explore associations among underlying hypertension, specific antihypertensive medications, and postoperative outcomes to investigate potential risk mitigation strategies.

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Title: Hypertension Requiring Medication Use: a Silent Predictor of Poor Outcomes After Pancreaticoduodenectomy
Authors: Jackie J. Lin
Patricia C. Conroy
Fernanda Romero-Hernandez
Mignote Yilma
Jean Feng
Kenzo Hirose
Eric Nakakura
Ajay V. Maker
Carlos Corvera
Kimberly Kirkwood
Adnan Alseidi
Mohamed A. Adam
Publication date: 09-01-2023
Publisher: Springer US
Keywords: Hypertension
Hypertension
Published in: Journal of Gastrointestinal Surgery / Issue 2/2023
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-022-05577-6

At a glance: The STEP trials

Springer Medicine

Hypertension Requiring Medication Use: a Silent Predictor of Poor Outcomes After Pancreaticoduodenectomy

Abstract

Background

Study Design

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Study Design

Results

Conclusions

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