title: Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy.
abstract: BACKGROUND
  Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out.
  
  
  METHODS
  Patients undergoing pancreatic resection from November 1, 2011 to December 31, 2012 were selected from the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project database. Pancreatic fistula was defined as drainage of amylase-rich fluid with drain continuation >7 days, percutaneous drainage, or reoperation for a pancreatic fluid collection. Univariate and multi-variable regression models were utilized to identify factors predictive of pancreatic fistula.
  
  
  RESULTS
  DFA1 was recorded in 536 of 2,805 patients who underwent pancreatic resection, including pancreaticoduodenectomy (n = 380), distal pancreatectomy (n = 140), and enucleation (n = 16). Pancreatic fistula occurred in 92/536 (17.2%) patients. DFA1, increased body mass index, small pancreatic duct size, and soft texture were associated with fistula (p < 0.05). A DFA1 cutoff value of <90 U/L demonstrated the highest negative predictive value of 98.2%. Receiver operating characteristic (ROC) curve confirmed the predictive relationship of DFA1 and pancreatic fistula.
  
  
  CONCLUSIONS
  Low DFA1 predicts the absence of a pancreatic fistula. In patients with DFA1 < 90 U/L, early drain removal is advisable.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
authors.forename: Christina W
authors.initials: CW
authors.lastname: Lee
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
authors.forename: Sean S
authors.initials: SS
authors.lastname: Ronnekleiv-Kelly
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Israel
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.forename: Abhishek D
authors.initials: AD
authors.lastname: Parmar
authors.forename: E Molly
authors.initials: EM
authors.lastname: Kilbane
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
mesh_terms: D000368:Aged; D000681:Amylases / Q000378:metabolism*; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D015331:Cohort Studies; D016208:Databases, Factual; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000681:Amylases
references.citation: Ann Surg. 2014 Apr;259(4):605-12
references.pmid: 24374513
references.citation: Am Surg. 2012 Oct;78(10):1143-6
references.pmid: 23025959
references.citation: J Am Coll Surg. 2014 May;218(5):978-87
references.pmid: 24680573
references.citation: Ann Surg. 2007 Aug;246(2):281-7
references.pmid: 17667507
references.citation: Surgery. 2005 Jul;138(1):8-13
references.pmid: 16003309
references.citation: HPB (Oxford). 2010 Sep;12(7):472-81
references.pmid: 20815856
references.citation: J Gastrointest Surg. 1998 Jul-Aug;2(4):373-8
references.pmid: 9841995
references.citation: J Gastrointest Surg. 2004 Dec;8(8):951-9
references.pmid: 15585382
references.citation: Ann Surg. 2001 Oct;234(4):487-93; discussion 493-4
references.pmid: 11573042
references.citation: World J Surg. 2008 Mar;32(3):419-28
references.pmid: 18175170
references.citation: Ann Surg. 2010 Aug;252(2):207-14
references.pmid: 20622661
references.citation: World J Surg. 2012 Apr;36(4):879-83
references.pmid: 22354484
references.citation: Ann Surg Oncol. 2011 Aug;18(8):2126-35
references.pmid: 21336514
references.citation: HPB (Oxford). 2010 Sep;12(7):488-97
references.pmid: 20815858
references.citation: Ann Surg. 2006 Jul;244(1):1-7
references.pmid: 16794381
references.citation: J Hepatobiliary Pancreat Sci. 2011 Jul;18(4):601-8
references.pmid: 21491103
references.citation: Ann Surg. 2006 Dec;244(6):931-7; discussion 937-9
references.pmid: 17122618
references.citation: Ann Surg. 2013 Dec;258(6):1051-8
references.pmid: 23360918
references.citation: World J Surg. 2013 Jun;37(6):1405-18
references.pmid: 23494109
references.citation: J Gastrointest Surg. 2011 Feb;15(2):250-9, discussion 259-61
references.pmid: 21161427
references.citation: J Gastrointest Surg. 2006 Apr;10(4):490-8
references.pmid: 16627213
references.citation: Arch Surg. 1998 Oct;133(10):1094-8
references.pmid: 9790207