Association Between Hypotension During Pancreatectomy and Development of Postoperative Diabetes

Context With advancements in long-term survival after pancreatectomy, postpancreatectomy diabetes has become a concern, and the risk factors are not yet established. Pancreatic islets are susceptible to ischemic damage, though there is a lack of clinical evidence regarding glycemic deterioration. Objective To investigate association between hypotension during pancreatectomy and development of postpancreatectomy diabetes. Design In this retrospective, longitudinal cohort study, we enrolled patients without diabetes who underwent distal pancreatectomy or pancreaticoduodenectomy between January 2005 and December 2018 from 2 referral hospitals in Korea. Main outcome measures Intraoperative hypotension (IOH) was defined as a 20% or greater reduction in systolic blood pressure. The primary and secondary outcomes were incident diabetes and postoperative Homeostatic Model Assessment (HOMA) indices. Results We enrolled 1129 patients (average age, 59 years; 49% men; 35% distal pancreatectomy). IOH occurred in 83% (median duration, 25 minutes; interquartile range, 5-65). During a median follow-up of 3.9 years, diabetes developed in 284 patients (25%). The cumulative incidence of diabetes was proportional to increases in the duration and depth of IOH (P < .001). For the median duration in IOH compared with a reference time of 0 minutes, the hazard ratio was 1.48 (95% CI, 1.14-1.92). The effect of IOH was pronounced with distal pancreatectomy. Furthermore, the duration of IOH was inversely correlated with 1-year HOMA β-cell function (P < .002), but not with HOMA insulin resistance. Conclusion These results support the hypothesis that IOH during pancreatectomy may elevate risk of diabetes by inducing β-cell insufficiency.