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                <idno type="eissn">1477-2574</idno>
                <title level="j">HPB</title>
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                  <publisher>Elsevier</publisher>
                  <date type="datePub">2023-10-26</date>
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              <idno type="doi">10.1016/j.hpb.2023.10.008</idno>
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              <p>Background: Data on clinically relevant post-pancreatectomy hemorrhage (CR-PPH) are derived from series mostly focused on pancreatoduodenectomy, and data after distal pancreatectomy (DP) are scarce.Methods: All non-extended DP performed from 2014 to 2018 were included. CR-PPH encompassed grade B and C PPH. Risk factors, management, and outcomes of CR-PPH were evaluated.Results: Overall, 1188 patients were included, of which 561 (47.2 %) were operated on minimally invasively. Spleen-preserving DP was performed in 574 patients (48.4 %). Ninety-day mortality, severe morbidity and CR-POPF rates were 1.1 % (n = 13), 17.4 % (n = 196) and 15.5 % (n = 115), respectively. After a median interval of 8 days (range, 0-37), 65 patients (5.5 %) developed CR-PPH, including 28 grade B and 37 grade C. Reintervention was required in 57 patients (87.7 %). CR-PPH was associated with a significant increase of 90-day mortality, morbidity and hospital stay (p &lt; 0.001). Upon multivariable analysis, prolonged operative time and co-existing POPF were independently associated with CR-PPH (p &lt; 0.005) while a chronic use of antithrombotic agent trended towards an increase of CR-PPH (p = 0.081). As compared to CR-POPF, the failure-to-rescue rate in patients who developed CR-PPH was significantly higher (13.8 % vs. 1.3 %, p &lt; 0.001).Conclusion: CR-PPH after DP remains rare but significantly associated with an increased risk of 90-day mortality and failure-to-rescue.</p>
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            <address>
              <addrLine>47-83 Boulevard de l'Hôpital, 75013 Paris</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.aphp.fr/contenu/hopital-universitaire-pitie-salpetriere-0</ref>
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        <org type="laboratory" xml:id="struct-102962" status="VALID">
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            <address>
              <addrLine>1 rue Germont 76031 Rouen cedex</addrLine>
              <country key="FR"/>
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            <ref type="url">https://www.chu-rouen.fr/service/chirurgie-digestive/</ref>
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              <addrLine>44000 Nantes</addrLine>
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              <country key="FR"/>
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            <ref type="url">http://www.chu-amiens.fr/patients-visiteurs/services-et-contacts/chirurgie/chirurgie-digestive-et-metabolique/</ref>
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            <address>
              <addrLine>Université de Picardie Jules Verne - CHU Amiens-Picardie - Service de Chirurgie Digestive - Bureau de la Recherche - 80054 Amiens Cedex 1</addrLine>
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              <addrLine>3, boulevard A. Fleming - 25030 Besançon Cedex</addrLine>
              <country key="FR"/>
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            <ref type="url">http://www.chu-besancon.fr/</ref>
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            <ref type="url">http://www.chru-lille.fr/</ref>
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            <address>
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            <ref type="url">http://www.chu-nancy.fr</ref>
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            <ref type="url">http://www.chru-strasbourg.fr/Hopital-de-Hautepierre</ref>
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              <country key="FR"/>
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          <orgName type="acronym">CHRU Montpellier</orgName>
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              <addrLine>191 avenue du doyen Gaston Giraud 34295 Montpellier</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.chu-montpellier.fr/fr/</ref>
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          <orgName type="acronym">HCL</orgName>
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              <addrLine>3 Quai des Célestins69002 Lyon</addrLine>
              <country key="FR"/>
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            <ref type="url">http://www.chu-lyon.fr/fr/hospices-civils-de-lyon-hcl</ref>
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          <orgName>Hôpital Nord [CHU - APHM]</orgName>
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              <addrLine>14 rue Paul Gaffarel - 21079 Dijon</addrLine>
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              <country key="FR"/>
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            <ref type="url">https://www.chu-clermontferrand.fr/les-sites/site-estaing</ref>
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            <ref type="url">https://www.chu-clermontferrand.fr/liste-poles/pole-specialites-medicales-et-chirurgicales</ref>
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            <ref type="url">https://www.chu-rouen.fr/</ref>
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          <idno type="ROR">https://ror.org/01k40cz91</idno>
          <orgName>Normandie Université</orgName>
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              <addrLine>Esplanade de la Paix - CS 14032 - 14032 Caen Cedex 5</addrLine>
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            <ref type="url">http://www.normandie-univ.fr/</ref>
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          <orgName type="acronym">UNIROUEN</orgName>
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            <ref type="url">https://www.chu-nice.fr/</ref>
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