Comparative outcomes analysis of Whipple procedure in dialysis-dependent patients: A propensity-matched study using NSQIP data

BACKGROUND: Pancreaticoduodenectomy (PD) presents a surgical challenge, and its feasibility in patients on dialysis is debated due to concerns over heightened perioperative risks. This study employs the NSQIP pancreatectomy database to investigate the impact of dialysis on PD-specific postoperative complications. METHODS: The NSQIP pancreatectomy targeted user file spanning 2014 to 2023 was used to identify patients undergoing a PD. Patients on dialysis were matched 1:3 to patients not receiving dialysis. Comparative analysis evaluated morbidity, mortality, and PD-specific complications. RESULTS: Among 43,565 patients who underwent a PD, 123 patients were on dialysis. Even after matching, dialysis patients displayed higher rates of complications, re-intubation, cardiac arrest, and bleeding (p < 0.001); furthermore, 30-day mortality was higher in the dialysis group (8.1% vs 3.0%, p = 0.014). However, rates of clinically relevant postoperative pancreatic fistula, delayed gastric emptying, and indwelling drain on POD 30 did not differ. CONCLUSIONS: Although dialysis patients undergoing PD face increased risks of mortality and complications, PD-specific complications were not affected. These findings offer valuable insights for patient counseling and surgeon awareness.