Hand grip strength predicts major complications following pancreaticoduodenectomy: A prospective observational study.

Backgrounds/aims: Although mortality after pancreaticoduodenectomy (PD) has decreased, morbidity remains high. The Modified Frailty Index (mFI) and hand grip strength (HGS) assessed preoperatively have been shown to predict postoperative morbidity and mortality after PD in retrospective studies. Our study aimed to evaluate the role of mFI and HGS in predicting outcomes following PD.

Methods: A prospective observational study conducted from June 2021 to March 2023 enrolled all consecutive patients undergoing PD. Preoperatively, patient characteristics, mFI, and HGS were calculated. Postoperative complications were graded according to the Clavien-Dindo (CD) classification. The statistical association between these complications with high mFI and weak HGS was analyzed.

Results: A total of 180 patients were enrolled in the study. Major complications (CD grade ≥ 3) and 90-day mortality occurred in 10.5% and 3.3% of patients, respectively. The proportion of patients with weak HGS was significantly higher among those who developed major complications (14 of 19) compared to those who did not (28 of 161) (p < 0.001). In contrast, high mFI did not reach statistical significance (p = 0.063). Additionally, weak HGS showed a statistically significant association with 90-day mortality (14.3% vs 0%, p < 0.001), hospital stay > 8 days (83.3% vs 24.6%, p < 0.001), 90-day re-admission (19.4% vs 4.3%, p = 0.002), and overall complications (30.7% vs 5.7%, p < 0.001), compared to normal HGS. Weak HGS was a significant predictor of major complications in multivariate analysis (adjusted odds ratio, 11.52; p < 0.0001).

Conclusions: HGS is a simple tool used preoperatively to assess functional sarcopenia and has been identified as an independent predictor of major complications following PD.