Risk factors analysis and predictive evaluation of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy
Objective To study the adverse risk factors for clinically relevant postoperative pancreatic fistula(CR-POPF)after pancreaticoduodenectomy(PD),determine the fistula risk score(FRS),and assess the predictive efficacy of amylase level in abdominal drainage fluid on postoperative day 1(DFA1).Methods A retrospective analysis was conducted on the clinical data of 105 patients,who underwent PD accepted in the Department of Hepatobiliary Pancreatic and Splenic Surgery Ward Ⅰ at the Affiliated Chuzhou Hospital of Anhui Medical University from January 2016 to January 2022.According to whether CR-POPF occurred,the patients were divided into CR-POPF group and non CR-POPF group.Univariate and multivariate analyses were performed to identify adverse risk factors affecting CR-POPF after PD.The predictive value of FRS and DFA1 for CR-POPF after surgery was validated using receiver operating characteristic curve(ROC).Based on FRS score,the patients were further divided into low segmentation group(0-2 points)and medium to high segmentation group(3-10 points).The perioperative diagnosis,treatment progress and occurrence of complications were compared between different segmentation groups.Results A total of 28 patients(26.7%)developed CR-POPF.Univariate and multivariate analysis revealed that FRS was an independent risk factor for CR-POPF after PD(OR=3.278,95%CI 2.021-5.319,P＜0.001).The area under the ROC curve for FRC predicting CR-POPF was 0.911(95%CI 0.857-0.965,P＜0.001),with sensitivity and specificity of 0.857 and 0.844,respectively.Further analysis of the various indicators in FRS showed that pancreatic texture and pancreatic duct diameter were significantly associated with CR-POPF(P＜0.05).The incidence of postoperative CR-POPF and infection in the middle-to-high segmen-tation group of FRS was much higher than that in the low segmentation group(P＜0.05).At the same time,the middle-to-high segmentation group had longer postoperative extubation and hospitalization time,higher readmission rate and in-hospital mortality rate(P＜0.05).ROC curve analysis of DFA1 values yielded an area under the curve of 0.777(95%CI 0.673-0.882,P＜0.001),with a calculated Youden index and critical value of 1 526.16 U/L.The sensitivity and specificity for predicting CR-POPF were 0.714 and 0.753,respectively.Conclusion FRS is an independent risk factor for the occurrence of CR-POPF after PD,and both FRS and DFA1 can accurately predict the occurrence of CR-POPF.For patients with FRS≥3 and DFA1＞1 526.16 U/L,early prevention,strengthened perioperative management,personalized intervention and treatment measures should be taken.
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