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26.11.2018 | Original Article

Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy—Stratification of Patient Risk

Zeitschrift:
Journal of Gastrointestinal Surgery
Autoren:
Ozgur Akgul, Katiuscha Merath, Rittal Mehta, J. Madison Hyer, Jeffery Chakedis, Brianne Wiemann, Morgan Johnson, Anghela Paredes, Mary Dillhoff, Jordan Cloyd, Timothy M. Pawlik
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11605-018-4045-x) contains supplementary material, which is available to authorized users.

Abstract

Background

Postoperative pancreatic fistula (POPF) remains a major cause of morbidity following pancreaticoduodenectomy (PD). We sought to develop and validate a risk score system that utilized preoperative computed tomography (CT) measurements, laboratory values, and intraoperative pancreatic texture to estimate risk of developing POPF after PD.

Methods

Patients who underwent PD between 2014 and 2017 were identified. Pre- and intraoperative risk factors associated with POPF were identified. Three separate risk models were developed and assessed using multivariable analyses and receiver operating curves.

Results

Among the 150 patients who underwent a PD, mean age was 64 years and the majority of the patients were male (59.3%, n = 89). Overall, the incidence of BL/POPF following PD was 22%. On multivariable analysis, factors associated with POPF included preoperative total serum protein < 6 g/dL (OR 3.35, 95% CI 1.04–10.34, p = 0.04), radiologic pancreatic duct diameter (OR 0.72, 95% CI 0.53–0.97, p = 0.03), intraoperative pancreatic gland texture estimated by surgeon (OR 0.17, 95% CI 0.05–0.62, p = 0.006), as well as intraoperative pancreatic duct diameter measured by surgeon (OR 0.77, 95% CI 0.61–0.98, p = 0.030). Each risk factor was assigned a weighted score (CT pancreatic duct diameter < 5 mm: 8 points; soft pancreatic gland texture: 5 points; total serum protein < 6 g/dL: 3 points; CT visceral abdominal fat ≥ 230 cm2: 2 points). Patients scoring 4–5 were at low risk of POPF, while patients with a score of 6–18 had a high risk for POPF. The Harrell’s c-index for the scoring system was 0.71 (standard error [SD] 0.094) for the training set and 0.67 (SD 0.034) for the test set (with n = 1000 bootstrapping resamples).

Conclusion

A simple risk score for POPF that utilized preoperative radiologic and clinical variables combined with specific intra-operative factors was able to stratify patients relative to POPF risk with good discriminatory ability.

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11605_2018_4045_MOESM1_ESM.tif
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