Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

A Retrospective Audit of Pancreatectomy Surgery and Diabetes (#298)

Shamendri Dasssanayake 1 , Neil Merrett 2 3 4 , Jeff Flack 1 3 4
  1. Diabetes Centre, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  2. Department of Surgery, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  3. Western Sydney University , Campbelltown, NSW, Australia
  4. University of NSW, Sydney, NSW, Australia

Background: Post-pancreatectomy diabetes is defined as endocrine pancreatic insufficiency occurring after surgical resection of the pancreas, leading to new onset diabetes or worsening glycaemic control in patients with pre-existing diabetes1. Poor glycaemic control may result in increased length of stay[LOS]2. We hypothesised that early, effective collaboration between Endocrinologists and Upper Gastrointestinal Surgeons would lead to reduced peri-operative diabetes-related complications and reduced LOS in these patients.

Aim: To evaluate patient outcomes and extent of physician-surgeon collaboration in managing glycaemic control in patients pre and post-pancreatectomy surgery.

Methods: We conducted a de-identified retrospective analysis of patients presenting to our hospital for pancreatic resection between 2012-2015, using data collected from the Department of Surgery electronic database and medical record charts. Data collected included: age, gender, reason for surgery, surgery type and peri-operative glycaemic management. We divided patients into three groups: patients with diabetes pre-surgery(Group1), patients who developed diabetes post-surgery(Group2) and patients who did not develop diabetes in hospital(Group3). We evaluated the involvement of the Endocrine team, development of immediate complications (DKA, hyperglycaemia), LOS and post-discharge management.

Results: There were 73 patients: mean±SD age 65.7±10.4 years with 46.6% male. Presentations were: 57 for pancreatic cancer, 6 for intra-ductal papillary mucinous neoplasms and 10 ‘other pathologies’. Surgeries were: 48 Whipple’s procedures, 9 total pancreatectomies, 10 distal pancreatectomies, and 6 subtotal pancreatectomies. For Group1(n=12), pre-operative therapy was oral hypoglycaemics[OHA](6), insulin(3) and OHA+insulin(3) and discharge therapy OHA(2), insulin(7), OHA+insulin(3). We found no evidence of pre-operative physician-surgeon collaboration. Sixteen patients(21.9%) developed hyperglycaemia post-surgery, 9 requiring insulin infusion, with no cases of DKA. Eight patients had involvement of the in-hospital diabetes team. The Table provides additional outcome data.


Conclusions: There was no evidence of pre-operative collaboration. Addition of the endocrine team to the existing multidisciplinary tumour group membership may enable collaborative development of improved referral and management pathways.

  1. 1. Johns Hopkins Diabetes Guide (2015) Post-Pancreatectomy Diabetes. Accessed January 18 2016, from
  2. 2. King, J., Kazanjian, K., Matsumoto, J., Reber, H. A., Yeh M. W., Hines, O.J., Eibl G. Distal pancreatectomy: incidence of postoperative diabetes. (2008). Journal of Gastrointestinal Surgery. 12(9):1548-53. doi: 10.1007/s11605-008-0560-5.