Preoperative handgrip strength (HGS) is a non-invasive measure that approximates muscle strength and has been linked to frailty in surgical patients. Reduced preoperative HGS is associated with increased postoperative complications, including prolonged hospitalization and increased mortality. Pancreatic resections have significant potential for postoperative complications, yet the best practices for normalizing preoperative HGS remain underexplored among patients undergoing pancreatic resection. This study aims to standardize assessment of HGS by number of trials, hand dominance, and intravenous (IV) catheter presence among patients undergoing pancreatic resections.
We evaluated consecutive patients undergoing pancreatectomy, including pancreatoduodenectomy, distal pancreatectomy, completion pancreatectomy, or total pancreatectomy, from August 2023 to July 2024 at a tertiary care center. HGS was measured preoperatively using a Jamar hand dynamometer, with three measurements per hand. Paired t-tests and ANOVA repeated measures were performed in R to compare HGS trials, among those with and without IV placement, and between dominant and non-dominant hands.
Our analysis included 104 patients, with a mean HGS of 30.2 kg (SD: 11.11 kg) and 27.7 kg (SD: 9.5 kg) for dominant and non-dominant hands, respectively. The difference in HGS between dominant and non-dominant hands was 3.9 kg with IV (95% CI: 2.0-5.7) and 1.9 kg without IV (1.2-2.7). Repeated measures within each hand were not significantly different (p=0.053 left, p=0.055 right). Significant differences were found between handedness for all trials (p=3.53e-10), between trials (p=0.031), and the interaction between IV placement and handedness (p=0.024). No significant differences were found for either dominant (p=0.88) or non-dominant hands (p=0.60) when evaluating HGS between trials and with or without IV placement within each.
HGS was significantly associated with dominant handedness and IV presence, but not number of trials. Understanding these relationships may help identify at-risk patients preoperatively, ultimately minimizing complications, augmenting adjuvant treatment, and improving quality of life. Future studies should investigate the association between HGS and postpancreatectomy complications.
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DeOliveira ML, Winter JM, Schafer M, et al. Assessment of Complications After Pancreatic Surgery: A Novel Grading System Applied to 633 Patients Undergoing Pancreaticoduodenectomy. Annals of Surgery. 2006;244(6):931-939. doi:10.1097/01.sla.0000246856.03918.9a
Freckelton J, Rajagopalan A, Moore GT, Croagh D. Handgrip Strength Predicts Survival in Patients With Pancreatic Cancer. Pancreas. 2024;53(5):e405-e409. doi:10.1097/MPA.0000000000002319
Kamphues C, Bova R, Schricke D, et al. Postoperative Complications Deteriorate Long-Term Outcome in Pancreatic Cancer Patients. Ann Surg Oncol. 2012;19(3):856-863. doi:10.1245/s10434-011-2041-4
Nakajima T, Ikuta S, Fujikawa M, et al. High hand grip strength is a significant risk factor and a useful predictor of postoperative pancreatic fistula following pancreaticoduodenectomy. Langenbecks Arch Surg. 2024;409(1):85. doi:10.1007/s00423-024-03274-3
Sánchez-Velázquez P, Muller X, Malleo G, et al. Benchmarks in Pancreatic Surgery: A Novel Tool for Unbiased Outcome Comparisons. Annals of Surgery. 2019;270(2):211-218. doi:10.1097/SLA.0000000000003223
Sato T, Aoyama T, Hayashi T, et al. Impact of preoperative hand grip strength on morbidity following gastric cancer surgery. Gastric Cancer. 2016;19(3):1008-1015. doi:10.1007/s10120-015-0554-4
Søreide K, Labori KJ. Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review. Scandinavian Journal of Gastroenterology. 2016;51(10):1147-1154. doi:10.3109/00365521.2016.1169317
Sultan P, Hamilton MA, Ackland GL. Preoperative muscle weakness as defined by handgrip strength and postoperative outcomes: a systematic review. BMC Anesthesiol. 2012;12(1):1. doi:10.1186/1471-2253-12-1