Impact of Osteopenia on Pancreatic Fistula in Patients Undergoing Pancreaticoduodenectomy

Background/Aim: This study aimed to identify the potential risk for postoperative pancreatic fistula (POPF), a major complication of pancreaticoduodenectomy. Patients and Methods: This retrospective study included 124 patients with biliary and pancreatic disorders who underwent pancreaticoduodenectomy between 2015 and 2020. Bone marrow density (BMD) was determined in the 11th thoracic vertebra using preoperative computed tomographic images. Delta BMD (dBMD=measured BMD − standard BMD) was calculated using standard BMD determined on the basis of age and sex, and dBMD <0 was defined as osteopenia. The relationship between clinicopathological factors and dBMD was investigated. Results: The average BMD level was 140 Hounsfield units. BMD was significantly lower in women than in men (p<0.01) and in older patients than in younger patients (p<0.01). POPF was significantly correlated with low dBMD (p=0.032). Osteopenia was a risk factor for POPF in patients with soft pancreas (p=0.016). Conclusion: Osteopenia was an independent risk factor for POPF after pancreaticoduodenectomy in patients with soft pancreas. Preoperative osteopenia assessment may be useful for the prediction of POPF, and preoperative vitamin D supplementation might be considered in patients with osteopenia.