Antihypertensive Medication Use: A Silent Predictor of Poor Outcomes after Pancreaticoduodenectomy

INTRODUCTION: Although hypertension requiring medication (HTNm) is a known cardiovascular comorbidity, its independent association with postoperative outcomes is understudied and potentially insufficiently acknowledged as a surgical risk factor. Therefore, we aimed to determine the independent association of HTNm with pancreaticoduodenectomy outcomes. METHODS: Adults undergoing elective pancreaticoduodenectomy were included from NSQIP-targeted dataset (2014 to 2019). The primary endpoint was significant complication (wound, cardiac, pulmonary, thrombotic, infectious, or renal complication, length of stay (LOS), reoperation, and/or death). Multivariable regression models compared outcomes by use of preoperative HTNm. Subset analysis of patients without comorbidity was done. RESULTS: Of 14,806 patients, 7,725 (52%) used HTNm preoperatively. HTNm was more common among older male patients with more comorbidities, functional dependency, hard pancreatic glands, and malignant pancreatic histology. However, after adjustment for these factors in addition to other demographic and clinicopathologic factors, HTNm was independently associated with higher odds of significant complication (odds ratio [OR] 1.20, p < 0.001), overall complication (OR 1.13, p = 0.002), renal (OR 2.15, p = 0.005), and cardiovascular (OR 1.70, p < 0.001) complication, and readmission (OR 1.16, p = 0.004; Table). There was no difference in fistula development or LOS between groups. Among patients without comorbidity, HTNm remained independently associated with significant morbidity (OR 1.26, p < 0.001), renal (OR 1.15, p = 0.002), and cardiovascular complication (OR 1.78, p = 0.002). Table. - Adjusted Postoperative Outcomes of Patients with Antihypertensive Medication Use Outcome Antihypertensive medication use: No (%) Antihypertensive medication use: Yes (%) Odds ratio (95% CI) p Value Significant morbidity 2,298 (32%) 3,060 (40%) 1.20 (1.11 to 1.31) <0.001 Any complication 3,490 (49%) 4,373 (57%) 1.13 (1.04 to 1.22) 0.002 Renal complication 22 (0.3%) 68 (0.9%) 2.15 (1.28 to 3.76) 0.005 Cardiovascular complication 90 (1.3%) 230 (3.0%) 1.70 (1.29 to 2.26) <0.001 Length of stay, median days (interquartile range) 7 (6–10) 8 (6–11) Coefficient: 0.12 (–0.14 to 0.38) 0.4 Unplanned Readmission 1,047 (15%) 1,355 (18%) 1.16 (1.05 to 1.29) 0.004 Clinically relevant postoperative pancreatic fistula (types B/C) 618 (8.8%) 732 (9.6%) 1.05 (0.92 to 1.20) 0.5 CONCLUSION: HTNm use is independently associated with cardiovascular and renal complications after pancreaticoduodenectomy and thus may be considered in preoperative evaluations. Future studies are needed to clarify how specific antihypertensive medication contributes to outcomes and investigate potential risk mitigation strategies.