Hypophosphatemia as a predictor of organ-specific complications following gastrointestinal surgery: Analysis of 8034 patients Journal Article


Authors: Sadot, E.; Zheng, J.; Srouji, R.; Strong, V. E.; Gönen, M.; Balachandran, V. P.; D’Angelica, M. I.; Allen, P. J.; DeMatteo, R. P.; Kingham, T. P.; Fong, Y.; Weiser, M. R.; Jarnagin, W. R.
Article Title: Hypophosphatemia as a predictor of organ-specific complications following gastrointestinal surgery: Analysis of 8034 patients
Abstract: Background: Organ-specific complications (OSC) remain serious potential sequela of gastrointestinal surgery. Hypophosphatemia correlates with poor outcomes and may be a harbinger of OSC after gastrointestinal surgery. Our goal was to describe and evaluate the relationship between postoperative phosphate levels and OSC. Methods: Consecutive patients who underwent pancreatic, colorectal, or gastric resections were analyzed. OSC were defined as those resulting from the failure of at least one anastomosis performed during the primary resection, manifesting as an anastomotic leak, fistula, and/or intra-abdominal abscess. Postoperative serum phosphate levels and other recognized OSC risk factors were compared among patients who did and did not develop OSC. Results: A total of 8034 patients who underwent pancreatic (n = 397), colorectal (n = 5808), or gastric (n = 1829) resections were included in the study. In each resection group, the majority of patients experienced hypophosphatemia postresection with the nadir on postoperative day (POD) 2, and the subgroups that developed OSC exhibited lower phosphate levels on POD3–7. On multivariate analysis, lower phosphate level on POD3 remained significantly associated with OSC following pancreatic resection [median (interquartile range) mmol/L, 0.65 (0.53–0.76) vs. 0.71 (0.61–0.84), p = 0.045] and colorectal resection [0.71 (0.61–0.87) vs. 0.77 (0.65–0.94), p = 0.006], and lower phosphate level on POD4 remained associated with OSC following gastric resection [0.87 (0.74–1.03) vs. 0.96 (0.81–1.13), p = 0.049]. Conclusion: This study identified a consistent trajectory of serum phosphate levels following 3 different gastrointestinal operations and association between early postoperative phosphate levels and OSC. Persistent lower phosphate levels should raise the level of concern for evolving postoperative leak and may lead to earlier radiographic evaluation and treatment. © 2018, Société Internationale de Chirurgie.
Journal Title: World Journal of Surgery
Volume: 43
Issue: 2
ISSN: 0364-2313
Publisher: Springer  
Date Published: 2019-02-01
Start Page: 385
End Page: 394
Language: English
DOI: 10.1007/s00268-018-4726-3
PUBMED: 29955938
PROVIDER: scopus
PMCID: PMC6310662
DOI/URL:
Notes: Correction issued, see DOI: 10.1007/s00268-018-4845-x -- Article -- Export Date: 1 February 2019 -- Source: Scopus
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MSK Authors
  1. Ronald P Dematteo
    588 Dematteo
  2. Mithat Gonen
    687 Gonen
  3. Martin R Weiser
    330 Weiser
  4. Peter Allen
    427 Allen
  5. William R Jarnagin
    569 Jarnagin
  6. Yuman Fong
    732 Fong
  7. T Peter Kingham
    281 Kingham
  8. Vivian Strong
    141 Strong
  9. Eran Sadot
    35 Sadot
  10. Jian Ying Zheng
    13 Zheng
  11. Rami Mahmoud Srouji
    1 Srouji