Management and outcomes of hemorrhage after distal pancreatectomy: a multicenter study at high volume centers

Background: Data on clinically relevant post-pancreatectomy hemorrhage (CR-PPH) are derived from series mostly focused on pancreatoduodenectomy, and data after distal pancreatectomy (DP) are scarce. Methods: All non -extended DP performed from 2014 to 2018 were included. CR-PPH encompassed grade B and C PPH. Risk factors, management, and outcomes of CR-PPH were evaluated. Results: Overall, 1188 patients were included, of which 561 (47.2 %) were operated on minimally invasively. Spleen -preserving DP was performed in 574 patients (48.4 %). Ninety -day mortality, severe morbidity and CR-POPF rates were 1.1 % (n = 13), 17.4 % (n = 196) and 15.5 % (n = 115), respectively. After a median interval of 8 days (range, 0-37), 65 patients (5.5 %) developed CR-PPH, including 28 grade B and 37 grade C. Reintervention was required in 57 patients (87.7 %). CR-PPH was associated with a significant increase of 90 -day mortality, morbidity and hospital stay (p < 0.001). Upon multivariable analysis, prolonged operative time and co -existing POPF were independently associated with CR-PPH (p < 0.005) while a chronic use of antithrombotic agent trended towards an increase of CR-PPH (p = 0.081). As compared to CR-POPF, the failure -to -rescue rate in patients who developed CR-PPH was significantly higher (13.8 % vs. 1.3 %, p < 0.001). Conclusion: CR-PPH after DP remains rare but significantly associated with an increased risk of 90 -day mortality and failure -to -rescue.