71593 - Diabetes mellitus in pancreatoduodenectomy: postoperative complications and mortality - A Swedish national register-based study

Abstract Introduction The prevalence of diabetes mellitus (DM) in patients undergoing pancreatoduodenectomy (PD) is high as well as the incidence of overall postoperative complications in patients with DM. This study aimed to analyze the effect of DM on complications and mortality in patients undergoing PD. Method Patients registered in the Swedish National Registry for Pancreatic and Periampullary Cancer 2010 to 2020 who underwent open PD were included. Data was cross-linked with the Swedish National Diabetes Register and postoperative complications and mortality were analyzed in patients with and without DM. A sub-analysis was performed to assess the impact of DM duration and HbA1c on complications. Result In total, 2 939 patients were included and 558 patients (19%) had DM. The incidence of pancreatic anastomotic leakage, PPH grade A-C and reoperation was lower in patients with DM (11% vs. 17%, p0.001; 6% vs. 10%, p=0.012; and 8%, vs. 10%, p=0.037, respectively). Patients with DM had a significantly lower risk of pancreatic anastomotic leakage (OR 0.13, p0.001), surgical and medical complications (Clavien Dindo ≥3a, OR 0.66 p=0.030 and OR 0.74 p=0.022, respectively) and estimated POPF grade C (OR 0.54, p=0.044). A 5-10 year DM duration and HbA1c 60-69 mmol/mol were protective of complications. Thirty day mortality and 90-day mortality were equal in patients with and without DM (both groups: 2%, p=0.922 and 3%, p=0.900, respectively). Discussion In this study, DM did not increase the risk of postoperative complications or mortality after PD, but rather seemed to lower the risk of pancreatic anastomotic leakage and postoperative complications.