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

Abstract

Postoperative pancreatic fistula is still a major complication after pancreatic surgery, despite improvements of surgical technique and perioperative management. We sought to systematically review and critically access the conduct and reporting of methods used to develop risk prediction models for predicting postoperative pancreatic fistula. We conducted a systematic search of PubMed and EMBASE databases to identify articles published before January 1, 2015, which described the development of models to predict the risk of postoperative pancreatic fistula. We extracted information of developing a prediction model including study design, sample size and number of events, definition of postoperative pancreatic fistula, risk predictor selection, missing data, modelbuilding strategies, and model performance. Seven studies of developing seven risk prediction models were included. In three studies (42 %), the number of events per variable was less than 10. The number of candidate risk predictors ranged from 9 to 32. Five studies (71 %) reported using univariate screening, which was not recommended in building a multivariate model, to reduce the number of risk predictors. Six risk prediction models (86 %) were developed by categorizing all continuous risk predictors. The treatment and handling of missing data were not mentioned in all studies. We found use of inappropriate methods that could endanger the development of model, including univariate pre-screening of variables, categorization of continuous risk predictors, and model validation. The use of inappropriate methods affects the reliability and the accuracy of the probability estimates of predicting postoperative pancreatic fistula.

Poor reporting of multivariable prediction model studies: towards a targeted implementation strategy of the TRIPOD statement

“…Our main finding of inadequate reporting in the majority of publications within 37 clinical domains is comparable to the findings of systematic reviews of prediction model studies performed in general medicine or specific clinical domains [ 6 – 11 ]. Inadequate reporting is considered to be a form of research waste [ 18 , 19 ].…”

“…Previous systematic reviews showed that within different clinical domains the quality of reporting of prediction models is suboptimal [ 6 – 11 ]. To improve the reporting of studies of prediction models, a guideline for the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) was launched in January 2015 in more than 10 medical journals [ 12 , 13 ].…”

Minimal reporting improvement after peer review in reports of COVID-19 prediction models: systematic review

“…The results of the current analysis, where we observed a median adherence of 42% (LQ-UQ: 31 to 57%) amongst published articles, were in line with findings from an earlier study by Heus et al [4] which reported a median adherence of 44% (LQ-UQ: 35 to 52) in 170 models across 37 clinical domains, in articles published prior to the publishing of the TRIPOD statement. Since the introduction of the TRIPOD statement [2,3], continued poor reporting has been observed [21][22][23], with the present analysis suggesting that current reporting quality in the field of COVID-19 prediction is no different to the situation prior to publication of the TRIPOD statement. This is likely due to the less rigorous peer review and editorial process for COVID-19 articles during the pandemic.…”

Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

“…Attention should be paid to the pathology of POPF. It has been reported that pancreatic fistula may be related to following aspects: 22 – 24 (1) When tissue and tissue are anastomosed, the needle passes through the pancreatic tissue and may break through the expanded small pancreatic duct, which may also cause pinhole infiltration, thereby causing leakage of pancreatic juice; (2) When the pancreas and intestine are anastomosed, there must be a gap between the needles, which causes pancreatic juice to leak out from the gap; (3) There is high pressure in the jejunal intestine tube. At the end of surgery, if the intestines cannot work normally and peristalsis is weak, and there is a long jejunal bridge after co-operating with the pancreas, this can easily cause pancreatic juice and bile retention in the intestine.…”