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Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy

  • 2014 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA

    Christina W. Lee, Sean S. Ronnekleiv-Kelly, Jacqueline S. Israel & Glen E. Leverson

  2. Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA

    Henry A. Pitt

  3. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA

    Taylor S. Riall & Abhishek D. Parmar

  4. Indiana University Health, Indianapolis, IN, USA

    E. Molly Kilbane

  5. Department of Surgery, School of Medicine, Washington University in St. Louis and Barnes Jewish Hospital, St. Louis, MO, USA

    Bruce L. Hall

  6. Department of Surgery, John Cochran Affairs Medical Center, St. Louis, MO, USA

    Bruce L. Hall

  7. Olin Business School and the Center for Health Policy, Washington University in St. Louis, St. Louis, MO, USA

    Bruce L. Hall

  8. BJC Healthcare, St. Louis, MO, USA

    Bruce L. Hall

  9. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, H4/730 Clinical Science Center, Madison, WI, 53792, USA

    Sharon M. Weber

Authors
  1. Christina W. Lee
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  2. Henry A. Pitt
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  3. Taylor S. Riall
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  4. Sean S. Ronnekleiv-Kelly
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  7. Abhishek D. Parmar
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  8. E. Molly Kilbane
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  9. Bruce L. Hall
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  10. Sharon M. Weber
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Corresponding author

Correspondence to Sharon M. Weber.

Additional information

Presentations:

• SSAT Quick Shots Presentation Digestive Disease Week 2014, Chicago, IL

• 48th Annual Pancreas Club Meeting, Chicago, IL

• 2014 ACS-NSQIP National Conference, New York, NY

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Lee, C.W., Pitt, H.A., Riall, T.S. et al. Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy. J Gastrointest Surg 18, 1902–1910 (2014). https://doi.org/10.1007/s11605-014-2601-6

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  • DOI: https://doi.org/10.1007/s11605-014-2601-6

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