title: Validation of Fistula Risk Score calculator in diverse North American HPB practices.
abstract: Fistula Risk Score (FRS) is a previously developed tool to assess the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD).
  
  
  
  Prospectively collected databases from 4 university affiliated and non-affiliated HPB centers in United States and Canada were used. The influence of individual baseline characteristics, FRS and FRS group on CR-POPF was assessed in univariate and multivariate analyses. FRS calculator performance was assessed using a C-statistic.
  
  
  
  444 patients were identified. Pathology, soft pancreas texture and pancreatic duct size were associated with CR-POPF rates (p < 0.001 for each); EBL was not (p = 0.067). The negligible risk group consisted of 50 (11.3%) patients, low risk of 118 (26.6%), moderate 234 (52.7%) and high risk group of 42 (9.5%) patients. The overall rate of CR-POPF was 20%. Of the patients in the negligible risk group, 2% developed CR-POPF, 13.6% of the low risk, 23.1% moderate and 42.9% in the high risk group (p < 0.001). Overall C-statistic was 0.719.
  
  
  
  FRS is robust and able to stratify the risk of developing CR-POPF following PD in diverse North American academic and non-academic institutions. The FRS should be used in research and to guide clinical management of patients post PD in these institutions.
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Grendar
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Jutric
authors.affiliation: Stanford Medical Center, Stanford University, Stanford, CA, USA.
authors.forename: Julie N
authors.initials: JN
authors.lastname: Leal
authors.affiliation: Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Bertens
authors.affiliation: Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.affiliation: Stanford Medical Center, Stanford University, Stanford, CA, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kastenberg
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Pippa H
authors.initials: PH
authors.lastname: Newell
authors.affiliation: Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Flavio
authors.initials: F
authors.lastname: Rocha
authors.affiliation: Stanford Medical Center, Stanford University, Stanford, CA, USA.
authors.forename: Brendan
authors.initials: B
authors.lastname: Visser
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Wolf
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA. Electronic address: phansen@orclinic.com.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D002170:Canada; D016009:Chi-Square Distribution; D000066491:Clinical Decision-Making; D016208:Databases, Factual; D003661:Decision Support Techniques; D005762:Gastroenterology / Q000592:standards; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000592:standards; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States