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Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy—Stratification of Patient Risk

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

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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Funding

Dr. Ozgur Akgul was supported by a grant from TUBITAK: Technology and Innovation Support Programs, Directorate of the Scientific and Research Council of Turkey.

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Authors and Affiliations

  1. The Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Oncology, Health Services Management and Policy, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Ozgur Akgul, Katiuscha Merath, Rittal Mehta, J. Madison Hyer, Jeffery Chakedis, Brianne Wiemann, Morgan Johnson, Anghela Paredes, Mary Dillhoff, Jordan Cloyd & Timothy M. Pawlik

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  1. Ozgur Akgul
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  2. Katiuscha Merath
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  3. Rittal Mehta
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Correspondence to Timothy M. Pawlik.

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The study was approved by the Institutional Review Board at The Ohio State University.

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Supplemental Figure 1

Pearson’s correlation analysis between preoperative measurement of pancreatic duct diameter with CT and intraoperative measurement of pancreatic duct diameter by the surgeon. (PNG 289 kb)

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Akgul, O., Merath, K., Mehta, R. et al. Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy—Stratification of Patient Risk. J Gastrointest Surg 23, 1817–1824 (2019). https://doi.org/10.1007/s11605-018-4045-x

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  • DOI: https://doi.org/10.1007/s11605-018-4045-x

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