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Postoperative Day 1 Drain Amylase After Pancreatoduodenectomy: Optimal Level to Predict Pancreatic Fistula

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Drain amylase on day 1 (DA-D1) after pancreaticoduodendectomy (PD) to predict occurrence of postoperative pancreatic fistula (POPF) is controversial. In this study, we evaluate the optimal DA-D1 level to predict clinically relevant POPF (CR-POPF).

Methods

The 2014–2020 NSQIP pancreatectomy-targeted database was queried for patients who underwent elective PD. Perioperative data was extracted to determine development of POPF and CR-POPF per International Study Group of Pancreatic Fistula guidelines. Receiver operative curve (ROC) and Youden’s index were used to assess the performance and optimal cutoff for DA-D1 to predict CR-POPF. The DA-D1 value was confirmed with a multivariable logistic regression to determine hazard ratios (HR) for CR-POPF and conditional logistic regression by modified fistula risk score (mFRS) subgroups.

Results

A total of 6,087 patients with complete perioperative data were included. Mean DA-D1 was 2,897 ± 8,636 U/L; median drain duration was 5 days. CR-POPF was documented in 544 (8.9%) patients. DA-D1 ROC for CR-POPF had area under the curve of 0.779 (95%CI 0.759–0.798). Youden’s index for the CR-POPF ROC coordinates had 77.6% sensitivity and 66.3% specificity, corresponding to DA-D1 values ≥ 720U/L as an optimal cutoff. CR-POPF was higher for patients with DA-D1 ≥ 720U/L (HR 4.6; p = 0.001). Patients DA-D1 < 720U/L with a negligible, low, intermediate, and high mFRS had respectively 1%, 3%, 4%, and 7% rate of CR-POPF.

Conclusion

DA-D1 < 720U/L after elective PD is a clinically useful predictor of CR-POPF. For patients with negligible to intermediate FRS, surgeons should consider utilizing DA-D1 < 720 U/L for removal of a drain on the first postoperative day.

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Data Availability

The data that support the findings of this study is from the National Surgical Quality Improvement Program. Requests to access and use the dataset should be directed to American College of Surgeons.

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Authors and Affiliations

  1. Cleveland Clinic, Department of General Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA

    Jenny H. Chang, Kathryn Stackhouse, Mir Shanaz Hossain, Robert Naples, Chase Wehrle, Toms Augustin, Robert Simon, Daniel Joyce, R. Matthew Walsh & Samer Naffouje

  2. Department of Surgical Oncology, Edward-Elmhurst Medical Group, Elmhurst, IL, USA

    Fadi Dahdaleh

Authors
  1. Jenny H. Chang
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  2. Kathryn Stackhouse
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  3. Fadi Dahdaleh
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Contributions

Study conception and design: Fadi Dahdaleh MD, Samer Naffouje MD.

Data Acquisition and analysis: Samer Naffouje MD.

Drafting of the manuscript: Jenny H. Chang MD, Kathryn Stackhouse MD MS, Samer Naffouje MD.

Critical revision: Jenny H. Chang MD, Kathryn Stackhouse MD, Mir Shanaz Hossain MD, Robert Naples DO, Chase Wehrle MD, Toms Augustin MD MPH, Robert Simon MD, Daniel Joyce MBBCh, R Matthew Walsh MD, Samer Naffouje MD.

Corresponding author

Correspondence to Samer Naffouje.

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Chang, J.H., Stackhouse, K., Dahdaleh, F. et al. Postoperative Day 1 Drain Amylase After Pancreatoduodenectomy: Optimal Level to Predict Pancreatic Fistula. J Gastrointest Surg 27, 2676–2683 (2023). https://doi.org/10.1007/s11605-023-05805-7

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