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Clinical effect of altitude level on surgical outcomes of pancreaticoduodenectomy for periampullary tumor: a multicenter study

Background The data on the effect of altitude on surgical outcomes after pancreaticoduodenectomy (PD) are lacking. This research is designed to determine the surgical outcomes of PD for periampullary tumor in high altitudes compared with normal altitudes. Patients and methods This is a multicenter propensity score-matched study. At the normal-altitude region, 90 patients had PD and 45 patients had PD in high-altitude region. The primary outcome was postoperative complications development. Secondary outcomes included operating time, blood loss intraoperative, postoperative complications, mortality, hospital stay, and postoperative pathology. Results There were insignificant differences in tumor size, site and nature, safety margin, number of lymph node dissected, perivascular infiltration, and perineural infiltration between the two groups. There were no significant differences in hospital stay, time to oral ingestion, and overall complications between the two groups. The primary delayed gastric emptying, deep venous thrombosis (DVT), and pulmonary embolism (PE) were significantly higher at high altitude. Hospital mortality at high altitude was higher (P=0.07), with the main cause being PE in high-altitude area. Conclusion Primary delayed gastric emptying is a high-altitude complication following PD. High altitude was related to a high incidence of venous thromboembolism. Hospital mortality at high altitude was higher, and PE was the principal cause. Extended postoperative therapy with low-molecular-weight heparin is recommended for 28 days to decrease the occurrence of PE and mortality.