Preoperative Liver Function Tests and Hemoglobin will Predict Complications Following Pancreaticoduodenectomy Christopher Hughes & Michael G. Hurtuk & Karen Rychlik & Margo Shoup & Gerard V. Aranha Received: 19 May 2008 / Accepted: 20 August 2008 / Published online: 12 September 2008 # 2008 The Society for Surgery of the Alimentary Tract Abstract Introduction Previous studies identified an association between dilated pancreatic and biliary ducts and lower rates of pancreatic leak after pancreaticoduodenectomy, but it remains unclear whether elevated liver function tests are also associated with lower rates of complications. The purpose of this study was to determine if preoperative liver function tests are associated with postoperative complications. Materials and Methods We identified 452 patients who received a pancreaticoduodenectomy from 1990–2007. Clinicopathological data was collected for each patient, and regression analyses were performed to identify predictors of postoperative complications. Results Of the patients studied, 289(64%) experienced no postoperative complications. In univariate analysis, patients with a low or normal preoperative aspartate aminotransferase (p =0.03) or alkaline phosphatase(p =0.03), had higher rates of complications. Multivariate analysis confirmed an elevated alkaline phosphatase was associated with a lower incidence of complications (OR=0.56, p =0.02), while preoperative anemia was found to be a predictor of complications following pancreaticoduodenectomy(OR =2.01, p =0.02). Conclusion Anemic patients and those with normal liver function tests were more likely to experience complications after pancreaticoduodenectomy. This may represent extent of disease and tumors not causing biliary or pancreatic dilatation, respectively. Precautions, such as intraoperative ductal stents, should be considered when operating on this group of patients to minimize complications. Keywords Pancreaticoduodenectomy . Preoperative laboratory values . Postoperative complications Introduction Pancreaticoduodenectomy (PD) remains the standard surgi- cal treatment for various pathologies of the pancreas and the periampullary area. In the period immediately following its inception, the procedure was associated with signifi- cantly high rates of intraoperative and postoperative complications, including a mortality rate of nearly 20%. 1,2 However, advances in surgical techniques and postopera- tive critical care have dramatically improved surgical outcomes after PD. 3–8 Several studies have demonstrated significant reductions in both morbidity and mortality associated with PD, especially in high-volume centers. 9–13 Nonetheless, PD remains a complicated surgical proce- dure that can significantly impact a patient’ s subsequent quality of life. Despite improvements in perioperative care, certain complications such as pancreatic leak, delayed J Gastrointest Surg (2008) 12:1822–1829 DOI 10.1007/s11605-008-0680-y Presented at the 49th Annual Meeting of the Society for Surgery of the Alimentary Tract, May 17–21, 2008. San Diego Convention Center, San Diego, California. C. Hughes Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA M. G. Hurtuk : M. Shoup : G. V. Aranha (*) Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, IL 60153, USA e-mail: garanha@lumc.edu K. Rychlik Department of Biostatistics, Loyola University Medical Center, Maywood, IL 60153, USA