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Clinical and Cost Profile of Controlled Grade B Postoperative Pancreatic Fistula: Rationale for Their Consideration as Low Risk

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Despite standardization, the 2016 ISGPF criteria are limited by their wider applicability and oversimplification of grade B POPF. This work applied the 2016 ISGPF grading criteria within a US academic cancer center to verify clinical and fiscal distinctions and sought to improve grading criteria for grade B POPF.

Methods

The 2008–2018 cost and NSQIP data from pancreaticoduodenectomy to postoperative day 90 were merged. All POPFs were coded by 2016 ISGPF criteria. The Clavien-Dindo Classification (CD) defined complication severity. On sub-analyses, grade B POPFs were divided into those with adequate drainage and those requiring additional drainage. Chi-square, ANOVA, and Fisher’s least significant difference test were employed.

Results

Two hundred thirty-two patients were in the final analyses, 72 (31%) of whom had POPFs: 16 (7%) biochemical leaks, 54 (23%) grade B (28% required additional drainage), and 2 (1%) grade C. There was no significant difference in length of stay, CD, readmission, or cost in patients without a POPF, with biochemical leak or grade B POPF. On sub-analyses, 92% of adequately drained grade B POPFs had CD 1–2 and readmission equivalent to patients without POPF (p > 0.05). One hundred percent of grade B POPF requiring drainage had CD 3–4a, and 67% were readmitted. Cost was significantly increased in grade B POPF requiring additional drainage (p = 0.02) and grade C POPF (p < 0.01).

Conclusions

This analysis did not confirm an incremental increase in morbidity and cost with POPF grade. Sub-analyses enabled accurate clinical and cost distinctions in grade B POPF; adequately drained grade B POPF are low risk and clinically insignificant.

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Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number T32 CA090217. This content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of General Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA

    Alexandra W. Acher, Christopher Stahl, James R. Barrett, Patrick B. Schwartz, Taylor Aiken, Sean Ronnekleiv-Kelly, Rebecca M. Minter, Glen Leverson, Sharon M. Weber & Daniel E. Abbott

  2. Clinical Science Center, 600 Highland Avenue, Box 7375, Madison, WI, 53792, USA

    Alexandra W. Acher

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  1. Alexandra W. Acher
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  2. Christopher Stahl
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Contributions

Alexandra W. Acher MD: Study design, data acquisition, data analysis and interpretation, manuscript writing and critical revision, final review and approval.

James R. Barrett MD: Study design, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Patrick B. Schwartz MD: Study design, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Christopher Stahl MD: Study design, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Taylor Aiken MD: Study design, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Sean Ronnekleiv-Kelly MD: Study design, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Rebecca M. Minter MD: Study design, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Glen Leverson PhD: Study design, data analysis, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Sharon M. Weber MD: Study design, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Daniel E. Abbott MD: Study design, interpretation of analysis, manuscript critical revision, manuscript final review and approval.

Corresponding author

Correspondence to Alexandra W. Acher.

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Acher, A.W., Stahl, C., Barrett, J.R. et al. Clinical and Cost Profile of Controlled Grade B Postoperative Pancreatic Fistula: Rationale for Their Consideration as Low Risk. J Gastrointest Surg 25, 2336–2343 (2021). https://doi.org/10.1007/s11605-021-04928-z

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  • DOI: https://doi.org/10.1007/s11605-021-04928-z

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