What is a better predictor of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD): postoperative day one drain amylase (POD1DA) or the fistula risk score (FRS)?
Both fistula risk score (FRS) and drain amylase in postoperative day 1 (POD1DA) have been promoted as tools to guide placement and removal of surgical drains following pancreaticoduodenectomy (PD). However, their individual utility has not been compared.



A consecutive cohort of PD patients from 2013 to 2015 were identified from a prospectively collected institutional database. Pearson correlation coefficients and receiver operating characteristic (ROC) curves were calculated for FRS (negligible/low vs. moderate/high) and POD1DA of 600 U/L and 5000 U/L as predictors of clinically relevant postoperative pancreatic fistula (CR-POPF).



The incidence of CR-POPF was 27% in 216 patients. Sensitivity and specificity of FRS, POD1DA >600 U/L, and POD1DA >5000 U/L for predicting CR-POPF were 83% and 55%, 94% and 60%, 33% and 90%. The ROC area under the curve (AUC) for POD1DA >600 U/L (0.764) and FRS (0.749) were not significantly different (p = 0.713). However, POD1DA >5000 U/L (0.615) was significantly worse at predicting CR-POPF (p = 0.015). When FRS and POD1DA >600 U/L were combined; there was no improvement (p = 0.624).



FRS and POD1DA are equally accurate in predicting CR-POPF. Patients with negligible/low FRS or POD1DA <600 U/L should be considered for drain removal.
Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Kimberly A
KA
Bertens
Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Angelena
A
Crown
Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Jesse
J
Clanton
Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Farzad
F
Alemi
Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Adnan A
AA
Alseidi
Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Thomas
T
Biehl
Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
William S
WS
Helton
Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA. Electronic address: Flavio.rocha@virginiamason.org.
Flavio G
FG
Rocha
D000368:Aged; D000681:Amylases / Q000378:metabolism*; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism; D004796:Clinical Enzyme Tests; D016208:Databases, Factual; D003661:Decision Support Techniques; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D000681:Amylases