Journal of Gastrointestinal Surgery

, Volume 18, Issue 11, pp 1902–1910 | Cite as

Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy

  • Christina W. Lee
  • Henry A. Pitt
  • Taylor S. Riall
  • Sean S. Ronnekleiv-Kelly
  • Jacqueline S. Israel
  • Glen E. Leverson
  • Abhishek D. Parmar
  • E. Molly Kilbane
  • Bruce L. Hall
  • Sharon M. WeberEmail author
2014 SSAT Quick Shot Presentation



Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out.


Patients undergoing pancreatic resection from November 1, 2011 to December 31, 2012 were selected from the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project database. Pancreatic fistula was defined as drainage of amylase-rich fluid with drain continuation >7 days, percutaneous drainage, or reoperation for a pancreatic fluid collection. Univariate and multi-variable regression models were utilized to identify factors predictive of pancreatic fistula.


DFA1 was recorded in 536 of 2,805 patients who underwent pancreatic resection, including pancreaticoduodenectomy (n = 380), distal pancreatectomy (n = 140), and enucleation (n = 16). Pancreatic fistula occurred in 92/536 (17.2 %) patients. DFA1, increased body mass index, small pancreatic duct size, and soft texture were associated with fistula (p < 0.05). A DFA1 cutoff value of <90 U/L demonstrated the highest negative predictive value of 98.2 %. Receiver operating characteristic (ROC) curve confirmed the predictive relationship of DFA1 and pancreatic fistula.


Low DFA1 predicts the absence of a pancreatic fistula. In patients with DFA1 < 90 U/L, early drain removal is advisable.


Pancreatectomy Drain fluid amylase Pancreatic fistula American College of Surgeons-National Surgical Quality Improvement Program 



The authors would like to acknowledge the Surgical Clinical Reviewers, Surgeon Champions, and pancreatic surgeons who participated in the Pancreatectomy Demonstration Project at the institutions listed below. We also wish to thank the leadership of the American College of Surgeons and of ACS-NSQIP for the opportunity to conduct the demonstration project.

• Albany Medical Center

• Ohio State University

• Baptist Memphis

• Oregon Health Sciences Center

• Baylor University

• Penn State University

• Baystate Medical Center

• Providence Portland

• Beth Israel Deaconess

• Sacred Heart

• Boston Medical Center

• Stanford University

• Brigham & Women’s Hospital

• Tampa General

• California Pacific Medical Center

• Thomas Jefferson University

• Cleveland Clinic

• University Alabama

• Emory University

• University of California Irvine

• Hospital University Pennsylvania

• University of California San Diego

• Intermountain

• University Iowa

• Indiana University

• University Kentucky

• Indiana University Methodist

• University Minnesota

• Johns Hopkins

• University Texas Medical Branch

• Kaiser Permanente San Francisco

• University Virginia

• Kaiser Walnut

• University Wisconsin

• Leigh Valley

• Vanderbilt University

• Massachusetts General

• Wake Forest University

• Mayo-Methodist

• Washington University St. Louis

• Mayo-St Mary’s

• Winthrop University

• Northwestern University


Conflict of Interest

BLH is a paid consultant to the ACS as Associate Director for the ACS-NSQIP.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Christina W. Lee
    • 1
  • Henry A. Pitt
    • 2
  • Taylor S. Riall
    • 3
  • Sean S. Ronnekleiv-Kelly
    • 1
  • Jacqueline S. Israel
    • 1
  • Glen E. Leverson
    • 1
  • Abhishek D. Parmar
    • 3
  • E. Molly Kilbane
    • 4
  • Bruce L. Hall
    • 5
    • 6
    • 7
    • 8
  • Sharon M. Weber
    • 9
    Email author
  1. 1.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of SurgeryTemple University School of MedicinePhiladelphiaUSA
  3. 3.Department of SurgeryUniversity of Texas Medical BranchGalvestonUSA
  4. 4.Indiana University HealthIndianapolisUSA
  5. 5.Department of Surgery, School of MedicineWashington University in St. Louis and Barnes Jewish HospitalSt. LouisUSA
  6. 6.Department of SurgeryJohn Cochran Affairs Medical CenterSt. LouisUSA
  7. 7.Olin Business School and the Center for Health PolicyWashington University in St. LouisSt. LouisUSA
  8. 8.BJC HealthcareSt. LouisUSA
  9. 9.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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