Risk factors and Diagnostic Indicators for postoperative acute pancreatitis in acute aortic dissection

Abstract

Abstract Objectives: To analyze the incidence, prognosis, risk factors and diagnostic indicatorsof postoperative acute pancreatitis (PAP) in cases of acute type A aortic dissection (ATAAD). Methods: We enrolled 639 patients with ATAAD who underwent thoracic aortic endovascular repair or open surgery at our center from January 2019 to October 2021, and reported the perioperative information. Once patients were diagnosed with PAP, we recorded the diagnostic features, including acute severe epigastric abdominal pain, pancreatic enzyme levels, and abdominal computed tomography or ultrasonography results. Results: PAP in cases of ATAAD was present in 13 patients (13/639, 2.04%), who had a higher proportion of postoperative complications and worse prognosis. The incidences of postoperative hypoxemia [12 (92.31%) vs. 196 (31.31%)], low cardiac output syndrome [2 (15.38%) vs. 13 (2.08%)], need for renal-replacement therapy (RRT) [7 (53.85%) vs. 116 (18.53%)], pneumonia [8 (61.54%) vs. 80 (12.78%)], and bacteremia [5 (38.46%) vs. 27 (4.31%)] were higher in patients with PAP than in the control group. The 90-day mortality of postoperative PAP was 30.77% (4/13). Logistic regression analysis identified coronary and/or atherosclerosis (OR: 7.768, 95%CI [1.463- 41.261], p=0.016), postoperative hypoxemia (OR: 24.429, 95%CI[2.003-298.008, p=0.012), low cardiac output syndrome (OR: 27.382, 95%CI [1.65-454.271, p=0.021), and lactate dehydrogenase level (OR: 1.021, 95%CI [1.005- 1.037], p=0.01) as significant independent risk factors for PAP. Severe epigastric pain is the main manifestation of PAP in ATAAD patients. Conclusions: PAP is a serious complication of ATAAD and is associated with poorer outcomes. Coronary and/or atherosclerosis, postoperative hypoxemia, low cardiac output syndrome, and higher lactate dehydrogenase levels are risk factors for PAP. In cases of progressively elevated pancreatic enzymes or positive abdominal symptoms, a computed tomography scan or magnetic resonance imaging should be performed immediately to rule out PAP.