E253: Handgrip strength is associated with pancreatic fistula following pancreatectomy and may predict inoperable disease

Pancreatectomy is associated with a high risk of complications, with postoperative pancreatic fistula (POPF) as a substantial driver. Preoperative prediction of POPF remains a significant challenge for surgical decision-making. Handgrip strength (HGS) has been studied in several populations as a predictor of postoperative outcomes. We sought to evaluate whether HGS and other preoperative characteristics are associated with postpancreatectomy complications in this pilot study.

Methods:

Demographic, clinical, morphometric, anthropometric, and frailty screening data for consecutive patients undergoing planned pancreatectomy at the University of New Mexico were collected prospectively. HGS was measured during the preoperative outpatient visit or in the preoperative holding area using a digital hand dynamometer. Preoperative variables included weight, body mass index (BMI), mean HGS, maximum HGS in either hand (maxHGS), serum albumin, prognostic nutritional index (PNI), and Risk Analysis Index (RAI) score. HGS parameters were also normalized to weight and BMI. Postoperative variables included POPF, Clavien-Dindo grade, and Comprehensive Complication Index (CCI). Data were analyzed using linear and binary logistic regression and Pearson correlation in SPSS.

Results:

40 patients (51.2% female) were included. 67.5% (27/40) underwent successful resection with either pancreatoduodenectomy or distal pancreatectomy, while 32.5% had aborted pancreatectomy for the intraoperative finding of unresectable and/or metastatic disease. Every HGS parameter was strongly correlated with RAI score (p=0.001-0.006). There was a strong negative association between maxHGS/BMI ratio and aborted pancreatectomy, although this fell just short of statistical significance (OR 0.141 (95% CI 0.019-1.044), p=0.055). For pancreatoduodenectomy (PD) patients (n=15), maxHGS/weight ratio was strongly predictive of CR-POPF (OR 24.269 (95% CI 1.051-560.153), p=.046) and strongly associated with CCI (p=0.047). HGS parameters, albumin, RAI score, and PNI were not otherwise predictive of CR-POPF or CCI.

Conclusions:

HGS may be an additional parameter in predicting CR-POPF and overall complication burden following PD. As such, HGS could be considered as an adjunct in preoperative selection of pancreatectomy patients. The findings of this study merit further validation in subsequent larger studies, specifically sensitivity analyses to determine appropriate HGS cutoffs.