Rapid postoperative reduction in prognostic nutrition index is associated with the development of pancreatic fistula following distal pancreatectomy.
BACKGROUND
Despite recent advances in surgical techniques and devices for pancreatic remnant closure, postoperative pancreatic fistula (POPF) still remains one of the common complications after distal pancreatectomy (DP). Identification of risk factors for POPF may lead to the development of new strategies to prevent this ominous complication.


METHODS
We retrospectively reviewed data on 44 patients undergoing DP with the use of a stapler to identify risk factors for POPF. Study variables included preoperative prognostic nutritional index (PNI) and reduction rate of PNI on postoperative day (POD) 7.


RESULTS
POPF occurred in 23 patients (52%), of which 13 (56%) were grade B or C. Univariate analyses comparing patients with POPF and those without POPF showed significant differences in body mass index (P = 0.0102), pancreatic thickness (P = 0.0134), white blood cell count on POD7 (P = 0.0432), C-reactive protein level on POD7 (P = 0.0123), and PNI reduction rate (P = 0.0471). A multivariate analysis revealed pancreatic thickness (P = 0.0121) and PNI reduction rate (P = 0.0165) to be significant factors for POPF. Furthermore, the PNI reduction rate was significantly higher in patients with clinically relevant (grade B/C) POPF than in those with no or grade A POPF (P = 0.0257). In most patients, the massive postoperative PNI reduction preceded the diagnosis of clinically relevant POPF.


CONCLUSIONS
These findings suggest that rapid postoperative reduction in PNI is associated with the development of POPF.
Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan. Electronic address: norisato@med.uoeh-u.ac.jp.
Norihiro
N
Sato
Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan.
Yasuhisa
Y
Mori
Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan.
Noritaka
N
Minagawa
Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan.
Toshihisa
T
Tamura
Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan.
Kazunori
K
Shibao
Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan.
Aiichiro
A
Higure
Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan.
Koji
K
Yamaguchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D010180:Pancreatectomy / Q000379:methods; D010182:Pancreatic Diseases / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling
Distal pancreatectomy; Nutritional index; Pancreatic fistula; Risk factor