# Frequency of lactate elevation following pancreatic surgery and its relationship to postoperative complications

## TL;DR

This study finds that lactate levels often rise after pancreatic surgery but are not reliable for predicting complications.

## Contribution

The study is the first to evaluate lactate's clinical utility in predicting complications after major pancreatic surgery.

## Key findings

- Lactate levels were higher after total pancreatectomy compared to partial resection.
- Lactate elevation was common but not predictive of postoperative complications.
- LHigh > 2.65 mmol/L had a weak association with complications.

## Abstract

Lactate is often elevated following major pancreatic surgery but the clinical relevance of this it not known.

A retrospective study including 491 consecutive patients undergoing major pancreatic surgery. Lactate upon arrival to post anaesthesia unit (L0), the morning following surgery (LPOD1) and the highest value within those two time points (LHigh) were examined. The primary outcome was postoperative complications (Clavien-Dindo IIIa-V) and the secondary outcomes were surgery specific complications and hospital length of stay.

Median lactate values were: L01.7 mmol/L (IQR: 1.2 –2.6), LPOD11.3 mmol/L (IQR: 0.9 –1.9) and LHigh 2.3 mmol/L (IQR 1.7 –3.1). There were no differences in lactate values at any measuring point between those developing complications and those that didn´t. AUROC analysis (0.531–0.581) and Youden´s index (0.08–0.17) indicated poor diagnostic performance. LHigh > 2.65 mmol/L was associated with Odds ratio 2.05 (1.34 –3.14) for developing postoperative complications. Plasma lactate was higher following total pancreatectomy compared to partial resection at all three time points.

Plasma lactate elevation in common following pancreatic surgery; however, this is of limited clinical use to predict complications. The relatively higher lactate following total pancreatectomy might be due to hormonal deficits inherent to this procedure.

Image, graphical abstract