title: Scoring System to Predict Pancreatic Fistula After Pancreaticoduodenectomy: A UK Multicenter Study.
abstract: OBJECTIVE
  To validate a preoperative predictive score of postoperative pancreatic fistula (POPF). Other risk factors for POPF were sought in an attempt to improve the score.
  
  
  BACKGROUND
  POPF is the major contributor to morbidity after pancreaticoduodenectomy (PD). A preoperative score [using body mass index (BMI) and pancreatic duct width] to predict POPF was tested upon a multicenter patient cohort to assess its performance.
  
  
  METHODS
  Patients undergoing PD at 8 UK centers were identified. The association between the score and other pre-, intra-, and postoperative variables with POPF was assessed.
  
  
  RESULTS
  A total of 630 patients underwent PD with 141 occurrences of POPF (22.4%). BMI, perirenal fat thickness, pancreatic duct width on computed tomography and at operation, bilirubin, pancreatojejunostomy technique, underlying pathology, T stage, N stage, R status, and gland firmness were all significantly associated with POPF. The score predicted POPF (P < 0.001) with a higher predictive score associated with increasing severity of POPF (P < 0.001). Stepwise multivariate analysis of pre-, intra-, and postoperative variables demonstrated that only the score was consistently associated with POPF. A table correlating the risk score to actual risk of POPF was created.
  
  
  CONCLUSIONS
  The predictive score performed well and could not be improved. This provides opportunities for individualizing patient consent and selection, and treatment and research applications.
authors.affiliation: *University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom †Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom ‡Royal Infirmary of Edinburgh, Edinburgh, United Kingdom §Kings College Hospital, London, United Kingdom ¶Morriston Hospital Swansea, Wales, United Kingdom ‖St James' University Hospital Leeds, West Yorkshire, United Kingdom **Royal Free Hospital London, London, United Kingdom; and ††Southampton University Hospital, Hampshire, United Kingdom.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sutcliffe
authors.forename: Ravi
authors.initials: R
authors.lastname: Marudanayagam
authors.forename: James
authors.initials: J
authors.lastname: Hodson
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Alex
authors.initials: A
authors.lastname: Navarro
authors.forename: Krashna
authors.initials: K
authors.lastname: Patel
authors.forename: Asif
authors.initials: A
authors.lastname: Jah
authors.forename: Sara
authors.initials: S
authors.lastname: Napetti
authors.forename: Anya
authors.initials: A
authors.lastname: Adair
authors.forename: Stefanos
authors.initials: S
authors.lastname: Lazaridis
authors.forename: Andreas
authors.initials: A
authors.lastname: Prachalias
authors.forename: Guy
authors.initials: G
authors.lastname: Shingler
authors.forename: Bilal
authors.initials: B
authors.lastname: Al-Sarireh
authors.forename: Roland
authors.initials: R
authors.lastname: Storey
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Smith
authors.forename: Nehal
authors.initials: N
authors.lastname: Shah
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Fusai
authors.forename: Jamil
authors.initials: J
authors.lastname: Ahmed
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004378:Duodenal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D059035:Perioperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom