title: Pancreatic fistulae: are we making progress?
abstract: OBJECTIVE
  Pancreatic fistulae constitute a morbid outcome of pancreatic surgery. Yet, a definition of a pancreatic fistula does not exist that can be reliably used to report on and study this outcome. We compare reported fistula, morbidity, and mortality rates with fistula parameters in order to identify high-risk fistulae predictive of morbid outcomes.
  
  
  METHODS
  A systematic literature review was performed; of 1426 articles identified, 43 articles ultimately met inclusion and exclusion criteria and were reviewed. Fistula, morbidity, and mortality rates as well as fistula definitions were extracted and then compared and graphically reported.
  
  
  RESULTS
  Thirty-two different definitions of pancreatic fistulae were found in 43 articles; only 24 articles defined fistulae according to all three parameters examined in this study. The data trends suggest that fistula, morbidity, and mortality rates have remained relatively stable since 1980. Further, drainage volumes, amylase levels, and length of drainage do not appear to correlate with reported morbidity or mortality rates.
  
  
  CONCLUSIONS
  This study suggests that pancreatic fistulae may not correlate with morbidity and mortality. Further, the parameters historically used to define fistulae do not appear to correlate with morbidity and mortality. A different system is needed to identify this outcome and determine its clinical significance.
authors.affiliation: Division of General Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Zoe E
authors.initials: ZE
authors.lastname: Parr
authors.forename: Francis R
authors.initials: FR
authors.lastname: Sutherland
authors.forename: Oliver F
authors.initials: OF
authors.lastname: Bathe
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
mesh_terms: D006801:Humans; D009017:Morbidity; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index