Impact of Abdominal Aortic Calcification After Major Hepatobiliary Pancreatic Surgery: A Retrospective Cohort Study

Background/Aim: The rate of postoperative morbidity after major hepatobiliary pancreatic (HBP) surgery is estimated to be high. We hypothesized that the frailty and insufficient blood supply of organs caused by arteriosclerosis may lead to increased severity of postoperative complications. The aim of this study was to clarify the relationship between abdominal aortic calcification (AAC) and severity of major HBP surgery postoperative complications. Patients and Methods: A total of 322 major HBP surgeries were performed in Hiroshima University Hospital, Japan from January 2010 to March 2018. The records of 214 patients were retrospectively analyzed to include those with hepatectomy in two or more segments. These included donor hepatectomy, hepatectomy with biliary tract reconstruction, and pancreaticoduodenectomy. We compared the baseline AAC levels (cut-off; 1,000 mm3) with their corresponding levels after HBP surgery complications developed. The complication severity was assessed using the Comprehensive Complication Index (CCI). Results: The high-AAC (N=71) group had significantly increased incidence rates of surgical site infections and a higher CCI, even after propensity matching. Multivariate analysis revealed that a higher AAC was an independent risk factor of severe postoperative complications (CCI ≥40) (OR=10.21, p<0.01). Conclusion: An increased AAC has a corresponding increase in postoperative complication severity after major HBP surgery. Careful anastomosis and infection control are required to prevent the progression of severe postoperative complications among high-AAC patients.