Revisiting the Pancreatic Fistula Risk Score: Clinical Nomogram Accurately Assesses Risk

2021 ◽  
pp. 000313482110474
Author(s):  
Abdimajid Mohamed ◽  
Laura Nicolais ◽  
Timothy L. Fitzgerald
Keyword(s):  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Neoadjuvant Treatment ◽  
Area Under The Curve ◽  
Patient Counseling ◽  
Improvement Program ◽  
Multiple Imputations ◽  
American Society ◽  
Fistula Risk Score

Objectives Surgeons have created numerous iterations of the pancreatic fistula risk score (FRS) to predict risk for clinically relevant postoperative pancreatic fistula (CR-POPF). The multitude of often conflicting models makes it difficult for surgeons to apply data in clinical practice. Methods We conducted a retrospective cohort study utilizing National Surgical Quality Improvement Program data from 2015 to 2018. The study included patients undergoing pancreaticoduodenectomy. Missing data were resolved with multiple imputations. Results The study included 5975 patients; 1018 (17%) had a CR-POPF. On multivariate analysis, male sex (odds ratio (OR) 1.60 CI: 1.29-1.98 P < .001), obesity (OR 1.65 CI: 1.31-2.08 P < .001), and soft gland texture (OR 3.21 CI: 2.45-4.23 P < .001) were all associated with increased odds of a CR-POPF. Variables not associated with CR-POPF included diabetes, preoperative bilirubin, preoperative albumin, and American Society of Anesthesiologists (ASA) classification. On multivariate analysis, duct diameter >6 mm (OR .52 CI: .34-.77 P = .001), pancreatic adenocarcinoma pathology (OR .67 CI: .53-.84 P < .001), and neoadjuvant treatment (OR .71 CI: .51-.98 P = .042) were all associated with decreased odds of a CR-POPF. We constructed a clinically relevant nomogram from this model known as the Portland FRS. Model characteristics were superior to previously published FRS models. The area under the curve (AUC) for the Portland FRS was .72 (CI: .704-.737). In comparison, AUCs for the Alternative and Seoul FRS were .70 and .64, respectively. Conclusion Utilizing readily available clinical data, the Portland FRS can accurately predict the risk for pancreatic fistula. The nomogram may assist surgeons in patient counseling and perioperative management.

scholarly journals Postoperative day 3 drain amylase versus fistula risk score: predicting clinically relevant postoperative pancreatic fistula following pancreatico-duodenectomy

2019 ◽  
Vol 7 (1) ◽  
pp. 227
Author(s):  
Nagesh Nayakarahally Swamy Gowda ◽  
Sathish Obalanarasimhaiah ◽  
Balakrishna N. Setty ◽  
Jyotirmay Jena ◽  
Mannem Manoj Kumar
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Enhanced Recovery ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Postoperative Management ◽  
Postoperative Pancreatic Fistula ◽  
Perioperative Morbidity ◽  
Drain Amylase ◽  
Fistula Risk Score

Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) remains the most common cause of perioperative morbidity following pancreatico-duodenectomy (PD). Early and accurate prediction of CR-POPF can be helpful in postoperative drain management as well as stratifying patients for enhanced recovery protocol after surgery. Both fistula risk score (FRS) and postoperative drain amylase levels have been analyzed in past. However, currently there is no clear consensus regarding the ideal predictor. Present study sought to assess the utility of postoperative day 3 drain amylase (POD-3DA) level as a predictor of CR-POPF in comparison with FRS.Methods: A retrospective analysis was done on 57 patients who underwent PD at our institute between 2014 to 2018. POPF was defined and graded in accordance with ISGPF definition. Receiver operating characteristic (ROC) analysis predicted a threshold of POD3DA >486 IU/l associated with CR-POPF. Sensitivity, specificity and odds ratios with 95%CI calculated and ROC curves were plotted for POD3DA of ≥500 IU/l and FRS (negligible/low vs. moderate/ high) as predictors of CR-POPF.Results: Incidence of POPF and CR-POPF was 63% and 32% respectively. Sensitivity and specificity of POD3DA ≥500 and moderate/high FRS for predicting CR-POPF were 83%, 79% & 78%, 51% respectively. Difference between ROC area under the curve (AUC) for POD3DA ≥500 IU/l (0.868) and FRS (0.692) was significant (p=0.028). Combining FRS and POD3DA ≥500 IU/l improved specificity (87%) at the cost of sensitivity (67%). The negative predictive value of POD3DA <500 IU/l and negligible/low FRS were 91.2% and 83.3% respectively.Conclusions: POD3DA level greater than 5 times of upper normal range is more precise at predicting CR-POPF, hence clinically more reliable for drain and postoperative management. 

scholarly journals Retrospective Comparative Analysis of POPF Using Fistula Risk Score According to Pancreaticoenterostomy Method

2021 ◽  
Vol 105 (1-3) ◽  
pp. 559-563
Author(s):  
Seungmin Lee ◽  
Kwang Yeol Paik
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Postoperative Pancreatic Fistula ◽  
Clinical Risk Score ◽  
Reconstructive Methods ◽  
Fistula Risk Score

Background The aim of this study is to examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) according to the fistula risk. Methods An institutional database was reviewed for patients undergoing PD between January 2008 and August 2019. A total of 159 patients were stratified into 4 groups according to the Clinical Risk Score-Pancreatic Fistula. POPF according to 4 risk groups was compared between PJ and PG. Results Of the 159 patients, 82 underwent PG (51.6%) and 77 underwent PJ (48.4%) reconstruction. POPF rate was 17.1% (n = 14) in the PG group and 12.9% (n = 10) in the PJ group (P = 0.51). POPF rates were not different in intermediate, low, and negligible risks between 2 reconstructive methods. In the high-risk group (n = 47), there were 4 POPFs (22.2%) in PJ group and 9 (31.0%) in the PG group, respectively (P = 0.74). Conclusion In PD, there was no superior method of reconstruction with regard to POPF, even in high-risk glands.

scholarly journals Fistula Risk Score-Adjusted Comparison of Postoperative Pancreatic Fistula between Laparoscopic versus Open Pancreatoduodenectomy

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S265
Author(s):  
Boram Lee ◽  
Yoo-Seok Yoon ◽  
Chang Moo Kang ◽  
Ho Kyoung Hwang ◽  
Ho-Seong Han ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Risk Score

Systematic analysis of parameters predicting pathological axillary status (ypN0 vs. ypN+) in patients converting from cN+ to ycN0 through primary systemic therapy (PST).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 560-560
Author(s):  
Cornelia Liedtke ◽  
Hans-Christian Kolberg ◽  
Laura Kerschke ◽  
Dennis Goerlich ◽  
Ingo Bauerfeind ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Tumor Biology ◽  
Model Performance ◽  
Area Under The Curve ◽  
Axillary Staging ◽  
Patient Counseling ◽  
Primary Systemic Therapy ◽  
Systematic Analysis ◽  
Logistic Regression Models ◽  
Leave One Out

560 Background: Optimization of axillary staging in patients converting from cN+ to ycN0 through PST is needed. The aim of this analysis was to develop a nomogram predicting the probability of ypN+ after PST based on clinical/pathological parameters. Methods: Patients converting from cN+ to ycN0 through PST from a prospective study (SENTINA arm C) were included. Univariate/multivariate analyses were carried out for 14 clinical/pathological parameters to predict ypN+ using logistic regression models. Odds ratios and 95% confidence intervals were reported. Model performance was assessed by leave-one-out cross-validation (LOOCV at .5 cut-offs) and ROC analyses. Calculations were performed using the SAS Software (Version 9.4). Results: 553 patients were assessed. Stepwise backward variable selection based on a multivariate analysis of all significant parameters resulted in a model (5M, Table, N = 369 evaluable) including ER (3.81; 2.25-6.44), multifocality (2.22; 1.26-3.92), LVI (9.16; 4.68-17.90), detection of SLN after PST (.50; .26-.95) and ycT (1.03; 1.01-1.06). In LOOCV, this model had an area under the curve of .81. Multivariate analysis of parameters available preoperatively showed an association between ypN0/ypN+, ER and ycT. Full subset selection resulted in a model (2M, N = 414) containing only ER (4.36; 2.80, 6.81) and ycT (1.04; 1.02, 1.07). Conclusions: A prediction model including parameters evaluable before/after definitive surgery resulted in a nomogram with acceptable accuracy. Limitation to parameters evaluable before surgery (i.e. ER, ycT) showed reduced accuracy that was comparable/superior to accuracy of using individual parameters. Since tumor biology was the strongest parameter in our models, we hypothesize that modern tumor biologic parameters such as gene expression profiling might optimize prediction of axillary status after PST improving patient counseling. [Table: see text]

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

HPB ◽  
2020 ◽  
Vol 22 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Mengyi Lao ◽  
Xiaozhen Zhang ◽  
Chenxiang Guo ◽  
Wei Chen ◽  
Qi Zhang ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
External Validation ◽  
Fistula Risk Score

Cervical Corpectomy: Complications and Outcomes

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS295-ONS302 ◽  
Author(s):  
Maxwell Boakye ◽  
Chirag G. Patil ◽  
Chris Ho ◽  
Shivanand P. Lad
Keyword(s):  
Type 1 Diabetes ◽  
Multivariate Analysis ◽  
Mortality Rates ◽  
Complication Rates ◽  
Improvement Program ◽  
Cervical Corpectomy ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Objective: Previously, information on cervical corpectomy complication rates has been obtained from retrospective analysis of single-institution data. The aim of this study was to report 30-day mortality and complication rates after cervical corpectomy using multicenter prospective data from the Veterans Affairs National Surgical Quality Improvement Program database. Methods: The National Surgical Quality Improvement Program database was used to identify 1560 patients who underwent cervical corpectomy in United States Veterans Affairs hospitals from 1997 to 2006. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on morbidity and mortality rates. Results: A total of 1560 patients underwent corpectomy, with an overall in-hospital mortality rate of 1.6%, a complication rate of 18.4%, and a mean length of stay of 6 days. Multivariate analysis identified age older than 80 years (odds ratio [OR], 21.24), history of Type 1 diabetes (OR, 2.36), American Society of Anesthesiologists class greater than 3 (OR, 6.93), and dependent functional status (OR, 3.17) as the most significant preoperative predictors of complications. Three or more corpectomy levels (OR, 2.46) and operative duration longer than 6 hours (OR, 3.45) were also found to be significant predictors of postoperative complications. Patients who underwent 3 or more levels of corpectomy had a return-to-operating room rate of 17.9% and a graft/instrumentation failure rate of 5.4% compared with those who underwent single-level corpectomy, who had rates of 6.2 and 1.87%, respectively. Patients who were returned to the operating room had significantly higher mortality rates (7.0 versus 1.2%) and accounted for 39.9% of the total number of complications. Multivariate analysis identified age, American Society of Anesthesiologists class, history of disseminated cancer, and diabetes as the most significant predictors of mortality. Patients with Type 1 diabetes had 4-fold higher mortality rates compared with patients with no history of diabetes or diet-controlled diabetes. Conclusion: We have analyzed the morbidity and mortality data on the largest series of corpectomy reported to date. We have demonstrated the impact of age, American Society of Anesthesiologists class, and number of operated levels on complication rates. Type 1 diabetes was established as a strong risk factor for 30-day mortality after cervical corpectomy.

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