title: Impact of postoperative pancreatic fistula on surgical outcome--the need for a classification-driven risk management.
abstract: 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.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421 Homburg, Saar, Germany.
authors.forename: Andreas Schmid
authors.initials: AS
authors.lastname: Frymerman
authors.forename: Jochen
authors.initials: J
authors.lastname: Schuld
authors.forename: Patrick
authors.initials: P
authors.lastname: Ziehen
authors.forename: Otto
authors.initials: O
authors.lastname: Kollmar
authors.forename: Christoph
authors.initials: C
authors.lastname: Justinger
authors.forename: Marco
authors.initials: M
authors.lastname: Merai
authors.forename: Sven
authors.initials: S
authors.lastname: Richter
authors.forename: Martin Karl
authors.initials: MK
authors.lastname: Schilling
authors.forename: Mohammed Reza
authors.initials: MR
authors.lastname: Moussavian
mesh_terms: 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