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

• Published in: World journal of surgery Vol. 43; no. 2; pp. 385 - 394
• Main Authors: Sadot, Eran, Zheng, Jian, Srouji, Rami, Strong, Vivian E., Gönen, Mithat, Balachandran, Vinod P., D’Angelica, Michael I., Allen, Peter J., DeMatteo, Ronald P., Kingham, T. Peter, Fong, Yuman, Weiser, Martin R., Jarnagin, William R.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 15.02.2019; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Anastomosis; Anastomosis, Surgical - adverse effects; Cardiac Surgery; Chemical industry; Complications; Digestive System Surgical Procedures - adverse effects; Failure analysis; Female; Fistulae; Gastrectomy - adverse effects; Gastrointestinal surgery; General Surgery; Humans; Hypophosphatemia; Hypophosphatemia - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Original Scientific Report; Pancreas; Pancreatectomy - adverse effects; Patients; Phosphate; Phosphates; Phosphates - administration & dosage; Phosphates - blood; Postoperative Complications - etiology; Risk analysis; Risk factors; Subgroups; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4726-3

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.