# Clinical relevance of intraoperative blood loss in pancreatic surgery: a systematic review and meta-analysis to reappraise the impact on post operative pancreatic fistula

## TL;DR

This study finds that intraoperative blood loss is a significant predictor of postoperative pancreatic fistula after pancreatic surgery.

## Contribution

The study provides updated evidence on the clinical relevance of intraoperative blood loss in predicting postoperative pancreatic fistula.

## Key findings

- Intraoperative blood loss was significantly higher in patients who developed postoperative pancreatic fistula.
- IBL was identified as an independent risk factor for POPF in 17 out of 26 studies reviewed.
- The meta-analysis included 10,008 patients and confirmed the association between IBL and POPF.

## Abstract

Postoperative pancreatic fistula (POPF) is the major complication following pancreatic surgery, significantly impacting patient outcomes. Intraoperative blood loss (IBL) represents a modifiable risk factor for POPF, but its actual clinical relevance is not clearly defined. This study explores the available literature to reappraise the association of IBL and the development of POPF.

A systematic review and meta-analysis of original studies published between January 2006 and August 2025, reporting IBL in patients undergoing pancreatic resections and its association with POPF were performed. Studies that used the International Study Group on Pancreatic Surgery (ISGPS) or the International Study Group on Pancreatic Fistula Definition (ISGPF) definitions for POPF were included. Qualitative synthesis included all eligible studies; quantitative meta-analysis was conducted for studies reporting IBL in both POPF and no-POPF groups.

A total of 26 studies were included in the qualitative review and 12 in the meta-analysis. Among 13,108 patients who underwent pancreatic resections, the overall POPF rate was 20%. IBL was identified as an independent risk-factor of POPF in 17 studies. The meta-analysis, which included 10,008 patients, showed that IBL was significantly higher in the POPF group compared to the no-POPF group [Mean difference (MD): 112.46 ml (30.39, 194.53), p = 0.01].

IBL is an independent predictor of POPF. Intraoperative measures to minimize its occurrence and magnitude are key to ameliorate the outcomes of pancreas surgery.

The online version contains supplementary material available at 10.1007/s00423-025-03902-6.