Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy

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 data-base. 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.

Leakage of an Invagination Pancreaticojejunostomy May Have an Influence on Mortality

“…21 Further details regarding the PDP have previously been published. [22][23][24][25][26] Study patients During the study period, 2805 patients underwent a pancreatic resection at the 43 participating institutions. Patients who underwent total pancreatectomy, distal pancreatectomy, enucleation, and minimally invasive PD were excluded.…”

“…The primary outcomes of this study were perioperative overall morbidity, serious morbidity as previously defined, [22][23][24][25][26] mortality, and POPF-associated mortality. Aside from the variables collected by general participation in ACS-NSQIP, the 43 institutions participating in the PDP recorded 24 additional pancreatectomyspecific variables.…”

Systematic review and meta-analysis of pancreatic amylase value on postoperative day 1 after pancreatic resection to predict postoperative pancreatic fistula

“…4,7,[17][18][19][20][21][22][23][24][25][26][27][28][29] The process of selecting trials for inclusion is shown in Figure 1. The characteristics of these 15 studies are shown in Table 1.…”

“…The Fagan plot in DPA1 for overall POPF [17][18][19][20][21][22][24][25][26][27][28][29] calculated that the positive post-test probabilities (post-test (þ)) were 0.57, 0.80, 0.92 respectively, and the negative posttest probabilities (post-test (À)) were 0.04, 0.10, 0.25 respectively when the pretest probability was 25% or 50% or 75%. For PPA1 [22,[27][28][29], the post-tests (þ) were 0.39, 0.66, 0.85 respectively, and the post-tests (À) were 0.12, 0.30, 0.56 respectively.…”

How Does Outcomes Research Help Advance Our Knowledge of Patient Outcomes in Hepatopancreaticobiliary Surgery?

“…The ACS-NSQIP Pancreatectomy Demonstration Project, for instance, seeks to provide a multitude of HPB-specific variables (preoperative biliary stent placement, pancreatic duct diameter and remnant gland texture, anastomotic technique and vascular resection, drain placement and amylase levels, rates of PF, and delayed gastric emptying (DGE)) so that outcomes researchers can address very precise questions on a much broader scale. [21][22][23] As an example, this pilot database has been utilized by Parmar et al 24 to identify PF formation, postoperative sepsis and reoperation as independent predictors of DGE following PD or total pancreatectomy. Similarly, multicenter consortiums are primed tools for investigating questions related to subspecialty-specific surgical outcomes and harbor the added benefit of promoting widespread collaboration and idea sharing among various facilities.…”