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World Journal of Surgery

, Volume 43, Issue 2, pp 385–394 | Cite as

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

  • 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. JarnaginEmail author
Original Scientific Report
  • 152 Downloads

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.

Abbreviations

OSC

Organ-specific complications

POD

Postoperative day

LRC

Leak-related complications

IAI

Intra-abdominal infection

CKD-EPI

Chronic kidney disease epidemiology collaboration

GFR

Glomerular filtration rate

WBC

White blood cell counts

IQR

Interquartile range

BMI

Body mass index

PDAC

Pancreatic ductal adenocarcinoma

IPMN

Intraductal papillary mucinous neoplasm

PNET

Pancreatic neuroendocrine tumor

NAMPT

Nicotinamide phosphoribosyltransferase

ERAS

Enhanced recovery after surgery

Notes

Funding

Funded in part by the NIH/NCI Cancer Center Support Grant P30 CA008748.

Compliance with ethical standards

Conflict of interest

All authors report no conflict of interests regarding this study.

Supplementary material

268_2018_4726_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 30 kb)

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Copyright information

© Société Internationale de Chirurgie 2018
Corrected publication November/2018

Authors and Affiliations

  • Eran Sadot
    • 1
    • 2
    • 3
  • Jian Zheng
    • 1
  • Rami Srouji
    • 1
  • Vivian E. Strong
    • 1
  • Mithat Gönen
    • 4
  • Vinod P. Balachandran
    • 1
  • Michael I. D’Angelica
    • 1
  • Peter J. Allen
    • 1
  • Ronald P. DeMatteo
    • 1
  • T. Peter Kingham
    • 1
  • Yuman Fong
    • 1
    • 5
  • Martin R. Weiser
    • 1
  • William R. Jarnagin
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryRabin Medical CenterPetah TikvaIsrael
  3. 3.Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  5. 5.Department of SurgeryCity of HopeDuarteUSA

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