The Severity of Postoperative Pancreatic Fistula Predicts 30-Day Unplanned Hospital Visit and Readmission after Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study

Background: Unplanned hospital visits (UHV) and readmissions after pancreaticoduodenectomy (PD) impact patients’ postoperative recovery and are associated with increased financial burden and morbidity. The aim of this study is to identify predictive factors related to these events and target the potentially preventable UHV and readmissions. Methods: We enrolled 518 patients in this study. Characteristics were compared between patients with or without UHV and readmissions. Results: The unplanned visit and readmission rate was 23.4% and 15.8%, respectively. Postoperative pancreatic fistula (POPF) grade B or C, the presence of postoperative biliary drainage, and reoperation were found to be predictive factors for UHV, whereas POPF grade B or C and the presence of postoperative biliary drainage were independently associated with hospital readmission. The most common reason for readmission was an infection, followed by failure to thrive. The overall mortality rate in the readmission group was 4.9%. Conclusions: UHV and readmissions remain common among patients undergoing PD. Patients with grade B or C POPF assessed during index hospitalization harbor an approximately two-fold increased risk of subsequent unplanned visits or readmissions compared to those with no POPF or biochemical leak. Proper preventive strategies should be adopted for high-risk patients in this population to maintain the continuum of healthcare and improve quality.

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Predictive Factors for Postoperative Pancreatic Fistula—A Swedish Nationwide Register-Based Study

World Journal of Surgery ◽

10.1007/s00268-020-05735-4 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4207-4213

Author(s):

C. Williamsson ◽

K. Stenvall ◽

J. Wennerblom ◽

R. Andersson ◽

B. Andersson ◽

...

Keyword(s):

Risk Factors ◽

Weight Gain ◽

Pancreatic Fistula ◽

Predictive Factors ◽

Biliary Drainage ◽

National Registry ◽

Preoperative Biliary Drainage ◽

Postoperative Pancreatic Fistula ◽

Periampullary Cancer ◽

High Bmi

Abstract Background A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort. Methods Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF. Results A total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo ≥3a, 75% vs. 21%, p < 0.001) and longer hospital stay (median 23 [16–35] vs. 11 [8–15], p < 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08, p < 0.001). Preoperative presence of diabetes (OR 0.52, p = 0.012) and preoperative biliary drainage (OR 0.34, p < 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41, p < 0.001). Weight gain ≥2 kg on postoperative day 1 was also a risk factor (OR 1.76, p < 0.001). Conclusion A high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.

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Risk Factors for Intra-Abdominal Infection after Pancreaticoduodenectomy – A Retrospective Analysis to Evaluate the Significance of Preoperative Biliary Drainage and Postoperative Pancreatic Fistula

Hepatogastroenterology ◽

10.5754/hge12060 ◽

2012 ◽

Author(s):

Fumiaki Watanabe ◽

Hiroshi Noda ◽

Hidenori Kamiyama ◽

Takaharu Kato ◽

Nao Kakizawa ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Retrospective Analysis ◽

Biliary Drainage ◽

Preoperative Biliary Drainage ◽

Postoperative Pancreatic Fistula ◽

Abdominal Infection ◽

Intra Abdominal Infection

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Predictive Factors for Postoperative Pancreatic Fistula

Annals of Surgery ◽

10.1097/sla.0000000000000577 ◽

2015 ◽

Vol 261 (4) ◽

pp. e99 ◽

Cited By ~ 18

Author(s):

Claudio Bassi ◽

Markus W. Buchler ◽

Abe Fingerhut ◽

Michael Sarr

Keyword(s):

Pancreatic Fistula ◽

Predictive Factors ◽

Postoperative Pancreatic Fistula

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Pancreaticogastrostomy Prevents Postoperative Pancreatic Fistula of Portal Annular Pancreas During Pancreaticoduodenectomy

International Surgery ◽

10.9738/intsurg-d-16-00044.1 ◽

2016 ◽

Vol 101 (11-12) ◽

pp. 550-553

Author(s):

Ippei Matsumoto ◽

Keiko Kamei ◽

Shumpei Satoi ◽

Takuya Nakai ◽

Yoshifumi Takeyama

Keyword(s):

Portal Vein ◽

Pancreatic Fistula ◽

Dorsal Surface ◽

Uncinate Process ◽

Postoperative Pancreatic Fistula ◽

The Body ◽

Annular Pancreas ◽

Exocrine Function ◽

Portal Annular Pancreas ◽

Increased Risk

Portal annular pancreas (PAP) is an asymptomatic congenital pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein and or the superior mesenteric vein. During pancreaticoduonectomy (PD), the presence of PAP significantly increased risk for postoperative pancreatic fistula (POPF) because specific management of 2 pancreatic resection planes with 1 or 2 pancreatic ducts is required for pancreatico-intestinal reconstruction. To reduce the risk of POPF, a shift of the resection plain to the left for 1 anastomosis is recommended. We report a case of PAP that was successfully performed PD with pancreaticogastrostomy (PG). PG was conducted with invagination of the 2 resected pancreatic planes together into the stomach to minimize resected volume of the pancreas. A 78-year-old male patient with PAP underwent PD due to a duodenal adenocarcinoma. Intraoperatively, the uncinate process extended extensively behind the portal vein and fused with the dorsal surface of the pancreatic body above the splenic vein. For pancreatico-intestinal reconstruction, PG was performed with invagination of the 2 resected pancreatic planes together into the stomach. The postoperative course was uneventful, and he was discharged on postoperative day 12. Endocrine and exocrine function of the pancreas were maintained well at 10 months after surgery. PG is one of the useful choices for patients with PAP to prevent POPF while maintaining the pancreatic endocrine and exocrine function after PD.

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The Effect of Preoperative Biliary and Pancreatic Drainage on Postoperative Pancreatic Fistula: A Retrospective Cohort Study

The Surgery Journal ◽

10.1055/s-0038-1639343 ◽

2018 ◽

Vol 04 (01) ◽

pp. e37-e42 ◽

Cited By ~ 2

Author(s):

John Manipadam ◽

Mahesh S. ◽

Jacob Kadamapuzha ◽

Ramesh H.

Keyword(s):

Cohort Study ◽

Pancreatic Fistula ◽

Biliary Drainage ◽

Harmful Effect ◽

Rare Event ◽

Preoperative Biliary Drainage ◽

Postoperative Pancreatic Fistula ◽

Study Cohort ◽

Biliary Stenting ◽

Pancreatic Anastomosis

Background Surgeons and endoscopists welcome routine preoperative biliary drainage prior to pancreaticoduodenectomy despite evidence that it increases complications. Its effect on postoperative pancreatic fistula is variably reported in literature. Simultaneous biliary and pancreatic drainage is rarely performed for very selected indications and its effects on postoperative pancreatic fistula are largely unknown. Our aim was to analyze the same while eliminating confounding factors. Methods Retrospective single center cohort study of patients who underwent pancreaticoduodenectomy over the past 10 years for carcinoma obstructing the lower common bile duct. Patients who underwent biliary stenting alone, biliary and pancreatic stenting, and no stenting prior to pancreaticoduodenectomy were the three study cohort groups and their records were scrutinized for the incidence of postoperative pancreatic fistula. Results Sixty-two patients underwent biliary stenting alone, 5 patients underwent both biliary and pancreatic stenting, and 237 patients were not stented in the adenocarcinoma group without chronic pancreatitis. The pancreatic fistula rate was similar in the patients who underwent biliary stenting alone when compared with the group which was not stented. (24/62 versus 67/237, odds ratio [OR] =0.619, confidence interval (CI) =0.345–1.112, p = 0.121). However, the patients who underwent both biliary and pancreatic stenting had a significant increase in postoperative pancreatic fistula compared with the not stented (p = 0.003). By univariate and multivariate analysis using Firth logistic regression, pancreatic texture (OR = 1.205, CI = 0.103–2.476, p = 0.032) and the presence of a biliary and pancreatic stent (OR = 2.695, CI = 0.273–7.617, p = 0.027) were the significant factors affecting pancreatic fistula. Conclusion Preoperative biliary drainage alone has no significant influence on postoperative pancreatic fistula except when combined with pancreatic stenting. We need more such studies from other centers to confirm that the rare event of preoperative biliary and pancreatic stenting has indeed this harmful effect on healing of postoperative pancreatic anastomosis.

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Predictive factors associated with postoperative pancreatic fistula after laparoscopic distal pancreatectomy: a 10-year single-institution experience

Surgical Endoscopy ◽

10.1007/s00464-015-4255-1 ◽

2015 ◽

Vol 30 (2) ◽

pp. 649-656 ◽

Cited By ~ 20

Author(s):

Arturo S. Mendoza ◽

Ho-Seong Han ◽

Soyeon Ahn ◽

Yoo-Seok Yoon ◽

Jai Young Cho ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Predictive Factors ◽

Laparoscopic Distal Pancreatectomy ◽

Postoperative Pancreatic Fistula ◽

Single Institution ◽

Factors Associated

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Predictive factors of postoperative pancreatic fistula after laparoscopic pancreatoduodenectomy

Annals of Translational Medicine ◽

10.21037/atm-20-1411 ◽

2021 ◽

Vol 9 (1) ◽

pp. 41-41

Author(s):

Jikuan Jin ◽

Guangbing Xiong ◽

Jiali Li ◽

Xingjun Guo ◽

Min Wang ◽

...

Keyword(s):

Pancreatic Fistula ◽

Predictive Factors ◽

Postoperative Pancreatic Fistula ◽

Laparoscopic Pancreatoduodenectomy

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Clinical Impact of Preoperative Cholangitis after Biliary Drainage in Patients who Undergo Pancreaticoduodenectomy on Postoperative Pancreatic Fistula

The American Surgeon ◽

10.1177/000313481408000122 ◽

2014 ◽

Vol 80 (1) ◽

pp. 36-42 ◽

Cited By ~ 7

Author(s):

Hiroaki Yanagimoto ◽

Sohei Satoi ◽

Tomohisa Yamamoto ◽

Hideyoshi Toyokawa ◽

Satoshi Hirooka ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Biliary Drainage ◽

Multivariate Analyses ◽

Preoperative Biliary Drainage ◽

Postoperative Pancreatic Fistula ◽

Prophylactic Antibiotics ◽

Clinical Background ◽

Study Population ◽

Independent Risk Factors

The objective of this study was to examine whether the development of cholangitis after preoperative biliary drainage (PBD) can increase the incidence of postoperative pancreatic fistula (POPF). The study population included 185 consecutive patients who underwent pancreaticoduodenectomy from April 2006 to March 2011. All patients were divided into two groups, which consisted of a “no PBD” group (73 patients) and a PBD group (112 patients). Moreover, the PBD group was divided into a “cholangitis” group (21 patients) and a “no cholangitis” group (91 patients). Clinical background, clinical outcome, and postoperative complications were compared between groups. All patients received prophylactic antibiotics using cefmetazole until 1 or 2 days postoperatively. There was no difference between noncholangitis and non-PBD groups except the frequency of overall POPF. Clinically relevant POPF and drain infection occurred in the cholangitis group significantly more than in the noncholangitis group ( P < 0.05). Univariate and multivariate analyses showed that development of preoperative cholangitis after preoperative biliary drainage and small pancreatic duct (less than 3 mm diameter) were independent risk factors for clinically relevant POPF. The frequency of clinically relevant POPF was 8 per cent (eight of 99) in patients without two risk factors, 19 per cent (15 of 80) in patients with one risk factor, and 50 per cent (three of six) in patients with both risk factors. The development of preoperative cholangitis after PBD was closely associated with the development of clinically relevant POPF under the limited use of prophylactic antibiotics.

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Significance of Preoperative Pancreatic MRI Findings in Predicting Factors for Postoperative Pancreatic Fistula after Distal Pancreatectomy for Pancreatic Cancer: A Retrospective Study

10.21203/rs.3.rs-641857/v1 ◽

2021 ◽

Author(s):

Masahiro Fukada ◽

Katsutoshi Murase ◽

Toshiya Higashi ◽

Ryoma Yokoi ◽

Hideharu Tanaka ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Predictive Factors ◽

Univariate Analysis ◽

Postoperative Pancreatic Fistula ◽

University Hospital ◽

Imaging Biomarkers ◽

Mri Findings ◽

Related Factors

Abstract Background: Postoperative pancreatic fistula (POPF) is the most serious complication of distal pancreatectomy (DP). For patients with pancreatic cancer (PC), POPF can have a negative effect on both short- and long-term prognoses. This study aimed to identify clinical outcomes of POPF after DP for PC and predictive factors for POPF.Methods: This retrospective, single-institution study comprised 48 patients with PC who underwent open DP (excluding simultaneous resection of other organs and other pancreatic diseases) between January 2010 and December 2020 at the Gifu University Hospital. We statistically analyzed patient-, pancreas-, cancer-, and surgery-related factors for predicting outcomes and risk factors for POPF. Results: According to the International Study Group of Pancreatic Fistula (ISGPF) definition and grading, 11 (22.9%) of 48 patients had POPF grades B and C. Among 22 related factors, POPF was significantly associated with pancreatic width (p = 0.04) and the pancreas-to-muscle signal intensity ratio (SIR) on T1-weighted magnetic resonance imaging (MRI, p = 0.02) in univariate analysis. In multivariate analysis, both pancreatic width (≥23 mm, odds ratio [OR] 9.37; 95% confidence interval [CI] 1.22–202.40; p = 0.03) and SIR on T1-weighted MRI (≥1.37, OR 17.10; 95% CI 2.38–359.04; p = 0.003) were identified as independent predictive factors for POPF. Conclusion: Pancreatic width and pancreas-to-muscle SIR on T1-weighted MRI significantly correlated with POPF after DP for PC. These parameters may be potential imaging biomarkers for predicting POPF in pancreatic surgery.

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