A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients.
OBJECTIVE
Postoperative pancreatic fistula (POPF) has a wide range of clinical and economical implications due to the difference of the associated complications and management. The aim of this study is to verify the applicability of the International Study Group of Pancreatic Fistula (ISGPF) definition and its capability to predict hospital costs.


METHODS
This is a retrospective study based on prospectively collected data of 755 patients who underwent pancreaticoduodenectomy in our institution between November 1996 and October 2006. A number of 147 patients (19.5%) have developed a POPF according to ISGPF definition.


RESULTS
Grade A fistula, which has no clinical impact, occurred in 19% of all cases. Grade B occurred in 70.7% and was successfully managed with conservative therapy or mini-invasive procedures. Grade C (8.8%) was associated to severe clinical complications and required invasive therapy. Pulmonary complications were statistically higher in the groups B and C rather than the group A POPFs (p < 0.005; OR 8). Patients with carcinoma of the ampullary region had a higher incidence of POPF compared to ductal cancer, with a predominance of grade A (p = 0.036). Increasing fistula grades have higher hospital costs (€11,654, €25,698, and €59,492 for grades A, B, and C, respectively; p < 0.001).


CONCLUSIONS
The development of a POPF does not always determine a substantial change of the postoperative management. Clinically relevant fistulas can be treated conservatively in most cases. Higher fistula severity corresponds to increased costs. The grading system proposed by the ISGPF allows a correct stratification of the complicated patients based on the real clinical and economic impact of the POPF.
Surgical and Gastroenterological Department, University of Verona, Verona, Italy.
Despoina
D
Daskalaki
Giovanni
G
Butturini
Enrico
E
Molinari
Stefano
S
Crippa
Paolo
P
Pederzoli
Claudio
C
Bassi
D000230:Adenocarcinoma / Q000191:economics* / Q000601:surgery*; D002288:Adenocarcinoma, Mucinous / Q000191:economics* / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000191:economics* / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000191:economics* / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000145:classification / Q000175:diagnosis* / Q000191:economics* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000191:economics*; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis* / Q000191:economics* / Q000601:surgery; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies