Impact of postoperative pancreatic fistula on surgical outcome--the need for a classification-driven risk management.
BACKGROUND
The International Study Group of Pancreatic Fistula (ISGPF) classification allows comparison of incidence and severity of postoperative pancreatic fistula (POPF). Its post hoc character, however, does not provide a guideline for the treatment of POPF in individual patient. We therefore studied the association of POPF type A-C on secondary surgical morbidity and mortality in patients undergoing pancreatic resection.


METHODS
Between 3/2001-12/2007, 483 patients underwent pancreatic resections. POPF were classified according to the ISGPF classification. All patient data were entered in a clinical data management system prospectively.


RESULTS
Patients who developed POPF had significantly more vascular but not other surgical complications than patients without POPF. Patients with POPF A had no vascular or surgical complications. Twenty one of the 29 patients with POPF C had surgical complications (17 vascular complications). Mortality attributed to surgical complications after POPF C was 5/29. A soft pancreatic consistency (OR 8.5; p < 0.008) and a high drain lipase activity on postoperative day 3 (OR 4.4; p = 0,065) were predictors for the development of POPF C.


CONCLUSIONS
POPF C is associated with vascular complications like erosion bleeding and other surgical complications like delayed gastric emptying or pleural effusions. A soft pancreatic consistency and a high drain lipase activity on postoperative day 3 are early predictors for the development of POPF C.
Frymerman
Andreas Schmid
AS
Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421 Homburg, Saar, Germany.
Schuld
Jochen
J
Ziehen
Patrick
P
Kollmar
Otto
O
Justinger
Christoph
C
Merai
Marco
M
Richter
Sven
S
Schilling
Martin Karl
MK
Moussavian
Mohammed Reza
MR
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000145:classification* / Q000401:mortality / Q000628:therapy; D011183:Postoperative Complications / Q000145:classification* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012308:Risk Management; D018709:Statistics, Nonparametric