Validation of Fistula Risk Score calculator in diverse North American HPB practices

Grendar, Jan; Jutric, Zeljka; Leal, Julie N.; Ball, Chad G.; Bertens, Kimberly A.; Dixon, Elijah; Hammill, Chet W.; Kastenberg, Zachary J.; Newell, Pippa; Rocha, Flavio G.; Visser, Brendan C.; Wolf, Ronald; Hansen, Paul

doi:10.1016/j.hpb.2017.01.021

Cited by 48 publications

(50 citation statements)

References 26 publications

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“…However, some studies have questioned the reliability and accuracy of intraoperative blood loss, [21][22][23] and two external validations demonstrated this is not a significant factor. 24,25 In light of these criticisms, Mungroop et al recently proposed alternative fistula score (a-FRS) that modifies and replaces existing FRS using large sample size cohort from international multicenters. 26 In the study, P duct diameter, pancreatic texture, and BMI were adopted as factors constituting the score, while intraoperative blood loss was excluded.…”

Section: Discussionmentioning

confidence: 99%

Nomogram for predicting postoperative pancreatic fistula

You

Han

Choi

et al. 2019

HPB

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Background: Previous studies analyzed risk factors for postoperative pancreatic fistula (POPF) and developed risk prediction tool using scoring system. However, no study has built a nomogram based on individual risk factors. This study aimed to evaluate individual risks of POPF and propose a nomogram for predicting POPF. Methods: From 2007 to 2016, medical records of 1771 patients undergoing pancreaticoduodenctomy were reviewed retrospectively. Variables with p < 0.05 in multivariate logistic regression analysis were included in the nomogram. Internal performance validation was executed using a repeated cross validation method. Results: Of 1771 patients, 222 (12.5%) experienced POPF. In multivariable analysis, sex (p = 0.004), body mass index (BMI) (p < 0.001), ASA score (p = 0.039), preoperative albumin (p = 0.035), pancreatic duct diameter (p = 0.002), and location of tumor (p < 0.001) were identified as independent predictors for POPF. Based on these six variables, a POPF nomogram was developed. The area under the curve (AUC) estimated from the receiver operating characteristic (ROC) graph was 0.709 in the train set and 0.652 in the test set. Conclusions: A POPF nomogram was developed. This nomogram may be useful for selecting patients who need more intensified therapy and establishing customized treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Nomogram for predicting postoperative pancreatic fistula

You

Han

Choi

et al. 2019

HPB

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“…It places an additional burden on the patient and the healthcare system by increasing postoperative complication severity, duration of hospitalization, readmission and reoperation rates, and the risk of mortality. [1][2][3][4][5][6] A method for reliable prediction of the risk of developing clinically significant POPF would therefore be extremely useful.…”

Section: Introductionmentioning

confidence: 99%

External validation of alternative fistula risk score (a-FRS) for predicting pancreatic fistula after pancreatoduodenectomy

Lao

Xiao-zhen

Guo

et al. 2020

HPB

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Background: The utility of the proposed alternative fistula risk score (a-FRS) for predicting risk of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) has not been validated widely. Methods: This retrospective analysis included data of patients undergoing open and laparoscopic PD during March 2012-May 2018 in our institution. The predictive abilities of a-FRS and original-FRS were compared. Risk factors for CR-POPF were also evaluated by multivariate regression analysis. Results: Of the 370 patients, 80 (21.62%) developed CR-POPF. The incidences of CR-POPF in patients classified as low risk, intermediate risk, and high risk by a-FRS were 5.88%, 24.38%, and 57.69%, respectively (R2 = 0.97). The incidences of CR-POPF in patients classified as negligible risk, low risk, intermediate risk, and high-risk by original-FRS were 0%, 8.62%, 21.51%, and 52.50%, respectively (R2 = 0.92). The area under the ROC curve (AUC) was 0.74 for a-FRS vs. 0.70 for original-FRS. The a-FRS performed better than original-FRS for prediction of CR-POPF in open PD patients (AUC: 0.74 vs. 0.69) and was comparable with original-FRS in laparoscopic PD patients (AUC: 0.70 vs. 0.72).

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“…The more recently established alternative FRS (a-FRS) instead addresses MPD, pancreatic texture, and body mass index (BMI) [16], ignoring blood loss and pathology. However, it still relies on intraoperative evaluations, and~50% patients are in a gray zone of moderate risk (FRS: 3À6) [14][15][16][17], so preoperative predictors of greater accuracy and specificity are needed. Moreover, beyond MPD diameter (included in both FRS and a-FRS), morphologic risk factors at pancreatic stump [18][19][20] (eg, pancreatic thickness, stump area) that directly impact anastomotic failure have been otherwise discounted.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography-adjusted fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy: Training and external validation of model upgrade

Shi

Gao

et al. 2020

eBioMedicine

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Background: To develop a modified Fistula Risk Score (FRS) for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD) based on both FRS and contrast-enhanced computed tomography (CE-CT). Methods: In this multicenter retrospective analysis, we focused on 990 consecutive patients with pancreatoduodenectomy performed at four institutions between 2009 and 2019. The enhanced CT-FRS model initially targeted 26 pre-and intraoperative factors, including CT descriptors, FRS elements and clinical factors, using LASSO-penalized multivariable logistic regression for predicting CR-POPF events in discovery (n = 718) and externally validated (n = 272) datasets. Probabilities generated were further correlated with histologic features of pancreatic stumps in 356 patients. C-indices were analyzed to compare the predictive potential between the original FRS and the CT-FRS. Findings: CR-POPF developed in 112 (15.6%) and 36 (13.2%) patients in discovery and validation datasets, respectively. The final CT-FRS construct, incorporating remnant pancreatic volume (RPV), stump area, fat and atrophy scores by CT, and main pancreatic duct size, offered significantly greater overall predictability than the original FRS in discovery (C-index: 0.825 vs 0.794; p = 0.04) and validation (0.807 vs 0.741; p = 0.05) cohorts. Importantly, it outperformed the FRS in patients at moderate risk levels (FRS: 3À6), showing remarkably improved C-indices (discovery: 0.729 vs 0.626 [p<0.001], validation: 0.722 vs 0.573 [p = 0.006]). CT-FRS probabilities increased in conjunction with less extensive pancreatic fibrosis (p<0.001), ample glandular acini (p<0.001), and advanced lipomatosis (p<0.001).

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Validation of Fistula Risk Score calculator in diverse North American HPB practices

Abstract: FRS is robust and able to stratify the risk of developing CR-POPF following PD in diverse North American academic and non-academic institutions. The FRS should be used in research and to guide clinical management of patients post PD in these institutions.

Cited by 48 publications

References 26 publications

Nomogram for predicting postoperative pancreatic fistula

Nomogram for predicting postoperative pancreatic fistula

External validation of alternative fistula risk score (a-FRS) for predicting pancreatic fistula after pancreatoduodenectomy

Computed tomography-adjusted fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy: Training and external validation of model upgrade

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