Clinical and Economic Validation of the International Study Group of Pancreatic Fistula (ISGPF) Classification Scheme

Abstract

Biochemical evidence of pancreatic fistula alone has no clinical consequence and does not result in increased resource utilization. Increasing fistula grades have negative clinical and economic impacts on patients and their healthcare resources. These findings validate the ISGPF classification scheme for pancreatic fistula.

An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

“…Nevertheless, the incidences were comparable to the overall incidences of the previous reports using these definitions [1,3,6,7,12,13,22,29] , or were even lower than those in cases restricted to the soft pancreas [9,10] . In a current objective definition by the ISGPF classification scheme, Pratt et al [35] reported an overall incidence of 11.9% in Grade B fistula and 3.4% in Grade C fistula, which were comparable with our results of 14.4% in Grade B fistula and 1.6% in Grade C fistula. A subgroup analysis of the incidences of pancreatic fistula limited to the soft pancreas in each Grade according to the ISGPF definition has not yet been reported to date.…”

“…They found the incidence of pancreatic fistula to range from 9.9% to 28.5% according to the different definitions applied. Pratt et al [35] also reported incidences of pancreatic fistula between 9.1% and 19.3% by applying different definitions to 176 patients undergoing a pancreaticoduodenectomy. As a result, it is quite important to use a universally accepted definition of pancreatic fistula to compare the different aspects of the new surgical method with the conventional one.…”

“…The incidence is estimated to be 5% to 30% [1,[5][6][7]34,35] , which varies according to the definition [34,35] . Many risk factors for pancreatic fistula have been disclosed, among which the most significant factors are thought to be a soft pancreatic texture, a narrow pancreatic duct, and a high output of pancreatic juice [3,[8][9][10][11][12][13] .…”

“…The amylase level in the peripancreatic external drain was measured on postoperative d 1, 3 and 6. In this study, a pancreatic fistula was defined by four internationally well-documented criteria, which are described as follows: (1) drainage of more than 50 mL per day of fluid with an amylase content above three times the serum amylase activity on and after postoperative d 10 as described by Yeo et al [30] (Definition A); (2) drainage of more than 50 mL per day of fluid with an amylase content above three times the serum amylase activity on and after postoperative d 7 as described by Park et al [31] (Definition B); (3) drainage of more than 10 mL per day of fluid with an amylase content above three times the serum amylase activity on and after postoperative d 4 as described by Buchler et al [32] and Pederzoli et al [33] (Definition C); (4) drainage of any measurable volume of fluid with an amylase content greater than three times the normal serum value on or after postoperative d 3 according to the International Study Group of Pancreatic Fistula (ISGPF) classification scheme [34,35] . According to the ISGPF definition, outcomes were divided into four grades: (1) no fistula; (2) Grade A: biochemical fistula without clinical sequelae; (3) Grade B: fistula that shows clinical symptoms or requires any therapeutic intervention; (4) Grade C: fistula with severe clinical sequelae.…”

Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality

“…However, postoperative pancreatic fistula (POPF) is still regarded as the most relevant complication after resective pancreatic surgery (distal pancreatectomy and pancreatoduodenectomy) because it potentially leads to deleterious secondary complications, increased health care costs, and prolonged hospital stay [1,2].…”