Impact of Preoperative Factors of Dialysis Patients Who Underwent Pancreaticoduodenectomy on Postoperative Complications, 30-Day and Operative Mortality: Analysis Using the Japanese National Clinical Database.

[BACKGROUND] Pancreaticoduodenectomy (PD) in dialysis patients is rare but carries a high risk of complications and mortality. This study aimed to identify preoperative factors associated with severe postoperative complications and mortality.

[METHODS] Using the Japanese National Clinical Database, 329 dialysis patients undergoing PD between 2016 and 2020 were retrospectively analyzed. Multivariable penalized logistic regression identified preoperative risk factors for Clavien-Dindo classification (CDC) grade ≥ 4 complications, 30-day mortality, operative mortality, postoperative sepsis, and postoperative pancreatic fistula (POPF) (grade B or C).

[RESULTS] CDC grade ≥ 4 complications, 30-day mortality, and operative mortality occurred in 10.3%, 5.5%, and 11.2%, respectively. Diet- or oral medication-treated diabetes (Odds ratio 5.19, 95% confidence interval 1.19-22.66) and insulin-treated diabetes (7.50, 1.61-34.93) independently predicted 30-day mortality. Serum albumin levels < 3.0 g/dL independently predicted operative mortality (2.72, 1.05-7.02), while cardiovascular disease showed a borderline association (2.15, 0.95-4.85). Elevated CRP was significantly associated with postoperative sepsis (2.47, 1.07-5.67), and pancreatic cancer was associated with a lower risk of POPF (grade B or C) (0.59, 0.37-0.94).

[CONCLUSIONS] Dialysis patients undergoing PD face perioperative risks. Early mortality is driven by acute metabolic and infectious vulnerability, whereas operative mortality reflects diminished physiologic reserve related to malnutrition and cardiovascular comorbidity.