A Prospectively Validated Clinical Risk Score Accurately Predicts Pancreatic Fistula after Pancreatoduodenectomy

Callery, Mark P.; Pratt, Wande B.; Kent, Tara S.; Chaikof, Elliot L.; Vollmer, Charles M.

doi:10.1016/j.jamcollsurg.2012.09.002

Cited by 1,010 publications

(1,013 citation statements)

References 37 publications

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“…Also, because the primary operator should alternate roles with the secondary operator, analyses comparing pancreatic fistula rates would be needed because secondary operators could potentially only be experienced in performing pancreaticojejunostomies. However, the experienced surgeon's overall incidence of clinically relevant pancreatic fistulas was 10.8% in this study, which is a similar rate to what other studies have reported 2, 3, 5. The pancreatic anastomosis technique has been considered to be the most important factor in fistula development 26, 27.…”

Section: Discussionsupporting

confidence: 85%

“…It is generally reported that the incidence of clinically relevant post‐operative pancreatic fistulas after PD is 7.6–36.4%,1, 2, 3, 4, 5 in accordance to the definition of the International Study Group of Pancreatic Fistula (ISGPF) 6. Researchers have suggested factors that affect pancreatic leakage after PD, including male gender, advanced age, post‐operative albumin level, intraoperative bleeding, soft pancreatic parenchyma, small pancreatic duct, drain amylase level on post‐operative day one, pancreatic parenchymal thickness and surgeon volume, among others 1, 7, 8, 9, 10, 11, 12, 13, 14…”

Section: Introductionmentioning

confidence: 99%

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Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Kim

Choi

et al. 2015

ANZ Journal of Surgery

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BackgroundMany studies have reported factors affecting pancreatic leakage after pancreaticoduodenectomy (PD), but there have been few reports on surgeon workload and post‐operative pancreatic fistula (POPF). This study was conducted to explore whether a surgeon's workload during PD impacts the occurrence of POPF.MethodsWe retrospectively analysed 270 consecutive patients who underwent PD between January 2008 and June 2013 by a single experienced surgeon. These patients were divided into those who underwent PD entirely by a single operator (group 1) and those who received reconstructions by other operators (group 2). Duct‐to‐mucosa pancreaticojejunostomy was performed on all patients. The International Study Group on Pancreatic Fistula criteria were used to define POPF.ResultsThere were 157 patients (58.1%) in group 1 and 113 patients (41.9%) in group 2. The post‐operative morbidity rate was comparable between the two groups (55.4% versus 52.2%; P = 0.603), but the clinical pancreatic fistula (grade B/C) rate was significantly different (10.8% versus 2.7%; P = 0.011). The overall post‐operative mortality was one patient (0.4%). Significant associations were found between clinical pancreatic fistulas and soft pancreas texture (P = 0.021), preoperative serum albumin level ≤3.5 g/dL (P = 0.012), other pathology besides pancreatic cancer (P = 0.027) and a single‐operator procedure (P = 0.019). A multivariate logistic regression analysis revealed that a single operator (odds ratio: 4.2, P = 0.029) was a significant predictive risk factor for clinically relevant POPF.ConclusionDividing the surgeon's workload in PD is associated with lower rates of POPF.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Kim

Choi

et al. 2015

ANZ Journal of Surgery

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“…Other diagnoses (eg, duodenal, biliary, and cystic lesions) more commonly have a soft gland and a less dilated duct. Studies have established gland texture and duct size to be consistent predictors of pancreatic leak after PD, [10][11][12][13][14] and recently published clinical risk scores for pancreatic fistula 15,16 have incorporated duct size, gland texture, and diagnosis. However, these risk scores do not take patient age into consideration, nor do they correlate other outcomes by diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

Bergquist¹,

Shubert²,

Ubl³

et al. 2016

HPB

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Background: Expected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5% in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. Methods:The American College of Surgeons NSQIP database was reviewed to identify patients (<80 and 80 years) who underwent PD from January 1, 2005, through December 31, 2012. High-and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes.Results: Pancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (80 y) undergoing PD was 6.1% for those with high-risk diagnoses vs 4.5% for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients 80 years with low-risk diagnoses. Conclusion:In patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication.Patients should receive preoperative counseling about their risk.

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“…Some studies have reported predictive systems for POPF grades B or C [17][18][19], and were very useful; however, we think it is important to estimate all grades of POPF. There was a case where a drain that was inserted following a pancreaticojejunostomy was removed due to the absence of abnormal discharge; however, infectious discharge was later discovered, and the drain was reinserted with fistulography.…”

Section: Discussionmentioning

confidence: 98%

“…Our study is based on a small number of patients. Many reports about POPF after PD comprise a large number of patients and some studies have more than two hundred patients [3,5,13,[17][18][19]. As our institute is not a high-volume center, we had difficulty accumulating patients undergoing PD.…”

Section: Discussionmentioning

confidence: 99%

A Rapid Predictive System for Pancreatic Fistula after Pancreaticoduodenectomy: A Report from a Low-Volume Center

Takeshima¹,

Kubochi²

2017

J Univer Surg

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A Prospectively Validated Clinical Risk Score Accurately Predicts Pancreatic Fistula after Pancreatoduodenectomy

Cited by 1,010 publications

References 37 publications

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

A Rapid Predictive System for Pancreatic Fistula after Pancreaticoduodenectomy: A Report from a Low-Volume Center

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