Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2025; 17(3): 100999
Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.100999
Retrospective analysis of delta hemoglobin and bleeding-related risk factors in pancreaticoduodenectomy
Yi-Min Lin, Chao Yu, Guo-Zhe Xian
Yi-Min Lin, Guo-Zhe Xian, Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Chao Yu, Department of Emergency Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
Co-first authors: Yi-Min Lin and Chao Yu.
Author contributions: Lin YM designed the study, collected and analyzed data, and wrote the manuscript; Yu C participated in the study’s conception, data collection, and assisted in writing the manuscript; Lin YM and Yu C they contributed equally to this article, they are the co-first authors of this manuscript; Xian GZ participated in study design and provided guidance; and all authors read and approved the final manuscript.
Supported by the Shandong Provincial Natural Science Foundation General Project, No. ZR2020MH248.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), approval No. 2024-403.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Zhe Xian, MD, PhD, Professor, Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Huaiyin District, Jinan 250021, Shandong Province, China. xianguozhe@sdfmu.edu.cn
Received: September 2, 2024
Revised: January 7, 2025
Accepted: February 7, 2025
Published online: March 27, 2025
Processing time: 174 Days and 18.8 Hours
Abstract
BACKGROUND

Objective and accurate assessment of blood loss during pancreaticoduodenectomy (PD) is crucial for ensuring the safety and efficacy of the procedure. While the visual method remains the most common clinical metric, many scholars argue that it significantly differs from actual blood loss and is inherently subjective.

AIM

To assess blood loss in PD via delta hemoglobin (ΔHb) and compare it with the visual method to predict bleeding-related risk factors.

METHODS

In this retrospective analysis, 1722 patients who underwent PD from 2017 to 2022 at Shandong Provincial Hospital were divided into three groups: Open PD (OPD), laparoscopic PD (LPD), and conversion to OPD (CTOPD). Intraoperative ΔHb (IΔHb) was calculated via preoperative and 72-hour-postoperative hemoglobin concentrations, and its association with visually obtained estimated blood loss (EBL) was analyzed. Perioperative ΔHb (PΔHb) was calculated via preoperative and predischarge hemoglobin concentrations. We compared the differences in IΔHb and PΔHb among the three groups, and performed univariate and multivariate regression analyses of IΔHb and PΔHb.

RESULTS

The preoperative general information of patients showed no statistically significant difference among the three groups (P > 0.05). The IΔHb in the OPD, LPD, and CTOPD groups were 22.00 (12.00, 36.00), 21.00 (10.00, 33.00), and 33.00 (18.12, 52.24) g/L, respectively; And the PΔHb in the OPD, LPD, and CTOPD groups were 25.87 (13.51, 42.00), 25.00 (14.00, 45.00), and 37.48 (21.64, 59.65) g/L, respectively, values significantly differed (P < 0.05). IΔHb and EBL were significantly correlated (r = 0.337, P < 0.001). The results of univariate and multivariate regression analyses indicated that American Society of Anesthesiologists (ASA) classification IV [95% confidence interval (CI): 2.330-37.811, P = 0.049] and preoperative total bilirubin > 200 μmol/L (95%CI: 2.805-8.673, P < 0.001) were independent risk factors for IΔHb (P < 0.05), and ASA classification IV (95%CI: 45.934-105.485, P < 0.001), body mass index > 24 kg/m2 (95%CI: 1.285-9.890, P = 0.011), and preoperative total bilirubin > 200 μmol/L (95%CI: 6.948-16.797, P < 0.001) were independent risk factors for PΔHb (P < 0.05).

CONCLUSION

There is a correlation between IΔHb and EBL in PD, so we can assess the patients’ intraoperative blood loss by the ΔHb method. ASA classification IV, body mass index > 24 kg/m², and preoperative total bilirubin > 200 μmol/L increased perioperative bleeding risk.

Keywords: Pancreaticoduodenectomy; Delta hemoglobin; Estimated blood loss; Postpancreatectomy hemorrhage; Risk factor

Core Tip: We collected the medical records of patients who underwent pancreaticoduodenectomy in Shandong Provincial Hospital from 2017 to 2022. We used the difference in hemoglobin concentration (delta hemoglobin) before and after surgery to assess the amount of perioperative bleeding in patients, compared with the estimated blood loss obtained by the visual method, and analyzed the correlation between the two. Moreover, univariate and multivariate regression analyses were performed on the patients’ delta hemoglobin to predict risk factors related to bleeding.