Incidence and predictors of splanchnic vein thrombosis and mortality following hepatobiliary and pancreatic surgery

Background Intraabdominal surgery is a known risk factor for splanchnic vein thrombosis (SVT). SVT incidence, management, and prognosis after hepatopancreatobiliary surgery are unknown. Objectives To determine the incidence and prognosis of SVT following hepatopancreatobiliary surgery and describe current practices in anticoagulation for postoperative SVT. Patients/Methods Multicenter retrospective cohort study of adults undergoing hepatopancreatobiliary surgery. Multivariable analyses for predictors of SVT, major bleeding, and 90-day mortality were performed. Results Of 1815 patients included, 89 (4.9%) had cirrhosis and 1532 (84.4%) had active cancer. The most frequent surgeries were pancreaticoduodenectomy (40.6%), open (30.7%), and laparoscopic (11.0%) liver resection. Sixty (3.3%) patients experienced SVT within 90 days of surgery. Among patients with SVT, 23.3% were symptomatic and 75.0% were treated with therapeutic anticoagulation. Planned duration of anticoagulation averaged 3 to 6 months. By multivariable analysis, SVT predictors were: operative time (adjusted odds ratio [aOR] per hour increase 1.32, 95% confidence interval [CI] 1.20-1.46), cirrhosis (aOR 3.22, 95% CI 1.28-8.10), and postoperative intraabdominal infection (aOR 2.99, 95% CI 1.72-5.19). Postoperative major bleeding occurred in 22.1% of patients and 4.0% died within 90 days. Predictors of postoperative mortality were age (aOR per 10-year increase 1.79, 95% CI 1.38-2.30), operative time (aOR 1.31 (1.17-1.45), cirrhosis (aOR 4.42, 95% CI 1.96-9.96), postoperative intraabdominal infection (aOR 2.66, 95% CI 1.55-4.57), postoperative major bleeding (aOR 4.12, 95% CI 2.36-7.30), and postoperative SVT (aOR 3.15, 95% CI 1.42-6.97). Conclusion SVT occurred in 1 in 30 patients after hepatopancreatobiliary surgery and was associated with a 3-fold independent increase in 90-day mortality.