Veno-arterial CO2 Pressure Difference to Arterio-venous O2 Difference Ratio & Blood Lactate Levels Are Predictors of Postoperative Outcome in Whipple Procedures

Traditional Perfusion Markers :Lactate

Measured via arterial blood gases sampling

Time frame: T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) in ICU

occurrence of Postoperative complications

• Anastomotic leak rate (pancreaticojejunostomy, hepaticojejunostomy), Delayed gastric emptying (DGE), Postoperative pancreatic fistula (POPF),

Time frame: within 3 days in ICU for complications, 30 days postoperatively for mortality

ICU length of stay

total ICU stay ( days)

Time frame: postoperative 3 days

Occurrence of post-operative complications

30-day mortality

Time frame: postoperatively within 1 month

occurrence of Organ dysfunction (AKI)

Organ dysfunction (AKI), a patient is considered to have AKI postoperatively if any one of the following occurs: Increase in serum creatinine ≥ 0.3 mg/dL (≥ 26.5 µmol/L) within 48 hours, OR Increase in serum creatinine to ≥ 1.5 times baseline, OR Urine output \< 0.5 mL/kg/hr for ≥ 6 hours.

Time frame: postoperatively within 3 days in ICU

occurrence of postoperative complication as acute liver dysfunction

Postoperative liver dysfunction is defined as new impairment in liver function occurring after surgery, typically within the first 48-72 hours, manifested by one or more of the following: 1.Hyperbilirubinemia Total bilirubin \> 2 mg/dL (34 µmol/L) OR a rise \> 50% from baseline, 2.Elevated Liver Enzymes Increase in AST or ALT greater than 2-3 × upper limit of normal (ULN) Coagulopathy INR ≥ 1.5

Time frame: postoperatively within 3 days