Drain data to predict clinically relevant pancreatic fistula.
BACKGROUND
Post-operative pancreatic fistula (POPF) is a common and potentially devastating complication of pancreas resection. Management of this complication is important to the pancreas surgeon.


OBJECTIVE
The aim of the present study was to evaluate whether drain data accurately predicts clinically significant POPF.


METHODS
A prospectively maintained database with daily drain amylase concentrations and output volumes from 177 consecutive pancreatic resections was analysed. Drain data, demographic and operative data were correlated with POPF (ISGPF Grade: A--clinically silent, B--clinically evident, C--severe) to determine predictive factors.


RESULTS
Twenty-six (46.4%) out of 56 patients who underwent distal pancreatectomy and 52 (43.0%) out of 121 patients who underwent a Whipple procedure developed a POPF (Grade A-C). POPFs were classified as A (24, 42.9%) and C (2, 3.6%) after distal pancreatectomy whereas they were graded as A (35, 28.9%), B (15, 12.4%) and C (2, 1.7%) after Whipple procedures. Drain data analysis was limited to Whipple procedures because only two patients developed a clinically significant leak after distal pancreatectomy. The daily total drain output did not differ between patients with a clinical leak (Grades B/C) and patients without a clinical leak (no leak and Grade A) on post-operative day (POD) 1 to 7. Although the median amylase concentration was significantly higher in patients with a clinical leak on POD 1-6, there was no day that amylase concentration predicted a clinical leak better than simply classifying all patients as 'no leak' (maximum accuracy = 86.1% on POD 1, expected accuracy by chance = 85.6%, kappa = 10.2%).


CONCLUSIONS
Drain amylase data in the early post-operative period are not a sensitive or specific predictor of which patients will develop clinically significant POPF after pancreas resection.
Moskovic
Daniel J
DJ
Michael E DeBakey Department of Surgery and Dan L Duncan Cancer Center, The Elkins Pancreas Center, Baylor College of Medicine, Houston, TX 77030, USA.
Hodges
Sally E
SE
Wu
Meng-Fen
MF
Brunicardi
F Charles
FC
Hilsenbeck
Susan G
SG
Fisher
William E
WE
D000368:Aged; D000681:Amylases / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013781:Texas; D013997:Time Factors; D015854:Up-Regulation
D015415:Biomarkers; D000681:Amylases
Surgery. 2006 Jun;139(6):735-42
16782427
ANZ J Surg. 2008 Apr;78(4):240-4
18366393
World J Surg. 2005 Oct;29(10):1325-8
16132406
Am J Surg. 1994 Oct;168(4):295-8
7524375
J Gastrointest Surg. 2007 Nov;11(11):1451-8; discussion 1459
17710506
Dig Surg. 2004;21(1):54-9
14707394
J Gastrointest Surg. 2008 Jan;12(1):51-6
17955317
World J Surg. 2008 Mar;32(3):419-28
18175170
Am J Surg. 2009 Jun;197(6):702-9
18778804
World J Gastroenterol. 2008 Nov 21;14(43):6648-54
19034967
J Am Coll Surg. 2007 Apr;204(4):588-96
17382217
J Gastrointest Surg. 2009 Jan;13(1):163-73
18496727
Br J Surg. 2006 Jan;93(1):73-7
16273533
HPB Surg. 2009;2009:404520
19461951
J Gastrointest Surg. 2006 Nov;10(9):1264-78; discussion 1278-9
17114013
ANZ J Surg. 2001 Sep;71(9):511-5
11527259
J Gastrointest Surg. 2005 Jul-Aug;9(6):837-42
15985241
Br J Surg. 2005 Sep;92(9):1059-67
16044410
Ann Surg. 2007 Aug;246(2):281-7
17667507
Hepatogastroenterology. 2002 Mar-Apr;49(44):553-5
11995494
Surgery. 2005 Jul;138(1):8-13
16003309
Arch Surg. 2008 May;143(5):476-81
18490557
Arch Surg. 1995 Sep;130(9):952-5
7661678
Hepatogastroenterology. 2008 Mar-Apr;55(82-83):717-21
18613441
Br J Surg. 2009 Jun;96(6):641-9
19434658
Am Surg. 2004 Mar;70(3):222-6; discussion 227
15055845
World J Gastroenterol. 2005 Apr 28;11(16):2456-61
15832417
Am J Surg. 2002 Jan;183(1):42-52
11869701
Ann Surg. 2001 Oct;234(4):487-93; discussion 493-4
11573042
J Am Coll Surg. 1997 Jul;185(1):18-24
9208956
Am J Surg. 2000 Aug;180(2):117-20
11044525
J Hepatobiliary Pancreat Surg. 2008;15(3):247-51
18535760
Ann Surg. 1997 Sep;226(3):248-57; discussion 257-60
9339931