Ecker, B. L. et al. (2019) Risk factors and mitigation strategies for pancreatic fistula after distal pancreatectomy. Annals of Surgery, 269(1), pp. 143-149. (doi: 10.1097/SLA.0000000000002491) (PMID:28857813)
Full text not currently available from Enlighten.
Abstract
Objective: To identify a clinical fistula risk score following distal pancreatectomy. Background: Clinically relevant pancreatic fistula (CR-POPF) following distal pancreatectomy (DP) is a dominant contributor to procedural morbidity, yet risk factors attributable to CR-POPF and effective practices to reduce its occurrence remain elusive. Methods: This multinational, retrospective study of 2026 DPs involved 52 surgeons at 10 institutions (2001–2016). CR-POPFs were defined by 2016 International Study Group criteria, and risk models generated using stepwise logistic regression analysis were evaluated by c-statistic. Mitigation strategies were assessed by regression modeling while controlling for identified risk factors and treating institution. Results: CR-POPF occurred following 306 (15.1%) DPs. Risk factors independently associated with CR-POPF included: age (<60 yrs: OR 1.42, 95% CI 1.05–1.82), obesity (OR 1.54, 95% CI 1.19–2.12), hypoalbuminenia (OR 1.63, 95% CI 1.06–2.51), the absence of epidural anesthesia (OR 1.59, 95% CI 1.17–2.16), neuroendocrine or nonmalignant pathology (OR 1.56, 95% CI 1.18–2.06), concomitant splenectomy (OR 1.99, 95% CI 1.25–3.17), and vascular resection (OR 2.29, 95% CI 1.25–3.17). After adjusting for inherent risk between cases by multivariable regression, the following were not independently associated with CR-POPF: method of transection, suture ligation of the pancreatic duct, staple size, the use of staple line reinforcement, tissue patches, biologic sealants, or prophylactic octreotide. Intraoperative drainage was associated with a greater fistula rate (OR 2.09, 95% CI 1.51–3.78) but reduced fistula severity (P < 0.001). Conclusions: From this large analysis of pancreatic fistula following DP, CR-POPF occurrence cannot be reliably predicted. Opportunities for developing a risk score model are limited for performing risk-adjusted analyses of mitigation strategies and surgeon performance.
Item Type: | Articles |
---|---|
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Jamieson, Professor Nigel |
Authors: | Ecker, B. L., McMillan, M. T., Allegrini, V., Bassi, C., Beane, J. D., Beckman, R. M., Behrman, S. W., Dickson, E. J., Callery, M. P., Christein, J. D., Drebin, J. A., Hollis, R. H., House, M. G., Jamieson, N. B., Javed, A. A., Kent, T. S., Kluger, M. D., Kowalsky, S. J., Maggino, L., Malleo, G., Valero, V., Velu, L. K.P., Watkins, A. A., Wolfgang, C. L., Zureikat, A. H., and Vollmer, C. M. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cancer Sciences |
Journal Name: | Annals of Surgery |
Publisher: | Lippincott, Williams & Wilkins |
ISSN: | 0003-4932 |
ISSN (Online): | 1528-1140 |
University Staff: Request a correction | Enlighten Editors: Update this record