Clinical Risk Score to Predict Pancreatic Fistula after Pancreatoduodenectomy

Independent External Validation for Open and Laparoscopic Approaches

Christopher R. Shubert, Amy E. Wagie, Michael B. Farnell, David M. Nagorney, Florencia Que, Kmarie Reid Lombardo, Mark Truty, Rory Smoot, Michael L. Kendrick

Research output: Contribution to journalArticle

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Abstract

Background A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. Study Design The CRS-PF was calculated from a retrospective review of patients undergoing PD from January 2007 to February 2014. Postoperative pancreatic fistula was graded using International Study Group of Pancreatic Fistula criteria. Grade B and C leaks were defined as clinically significant. Performance was measured based on sensitivity, specificity, positive and negative predictive value, accuracy, and R2. Results There were 808 patients who met inclusion criteria; 539 (66.7%) had open and 269 (33.3%) had laparoscopic PD. The CRS-PF was high risk in 134 patients, intermediate in 492, low in 135, and negligible in 47. Postoperative pancreatic fistula occurred in 191 (23.6%) patients (grade A, 3.8%; B, 14.2%; and C, 5.6%), and it increased with risk category (R2 = 0.935 all, 0.898 open, and 0.968 laparoscopic). High and intermediate risk categories were combined and classified as "test positive," and negligible and low risk categories were combined and classified "test negative," resulting in a CRS-PF with a sensitivity of 95% and a negative predictive value of 96% for predicting POPF. Contrary to previous studies, grade A POPF increased with increasing CRS-PF and POPF did not correlate with estimated blood loss (R2 = 0.04). Conclusions The CRS-PF was validated independently by predicting POPF for both laparoscopic and open PD. Predictive performance was at least as good for laparoscopic PD as for open PD. Lack of correlation with estimated blood loss suggests CRS-PF might be tailored for improved performance. The CRS-PF is a clinically useful tool for POPF risk stratification after PD and allows for targeted intra- and postoperative measures to address patients at increased risk.

Original languageEnglish (US)
Article number7917
Pages (from-to)689-698
Number of pages10
JournalJournal of the American College of Surgeons
Volume221
Issue number3
DOIs
StatePublished - Sep 1 2015

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Pancreatic Fistula
Pancreaticoduodenectomy

Keywords

  • Abbreviations and Acronyms CRS-PF clinical risk score for pancreatic fistula
  • EBL estimated blood loss
  • PD pancreatoduodenectomy
  • PF pancreatic fistula
  • POPF postoperative pancreatic fistula

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Clinical Risk Score to Predict Pancreatic Fistula after Pancreatoduodenectomy : Independent External Validation for Open and Laparoscopic Approaches. / Shubert, Christopher R.; Wagie, Amy E.; Farnell, Michael B.; Nagorney, David M.; Que, Florencia; Reid Lombardo, Kmarie; Truty, Mark; Smoot, Rory; Kendrick, Michael L.

In: Journal of the American College of Surgeons, Vol. 221, No. 3, 7917, 01.09.2015, p. 689-698.

Research output: Contribution to journalArticle

Shubert, Christopher R. ; Wagie, Amy E. ; Farnell, Michael B. ; Nagorney, David M. ; Que, Florencia ; Reid Lombardo, Kmarie ; Truty, Mark ; Smoot, Rory ; Kendrick, Michael L. / Clinical Risk Score to Predict Pancreatic Fistula after Pancreatoduodenectomy : Independent External Validation for Open and Laparoscopic Approaches. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 3. pp. 689-698.
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abstract = "Background A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. Study Design The CRS-PF was calculated from a retrospective review of patients undergoing PD from January 2007 to February 2014. Postoperative pancreatic fistula was graded using International Study Group of Pancreatic Fistula criteria. Grade B and C leaks were defined as clinically significant. Performance was measured based on sensitivity, specificity, positive and negative predictive value, accuracy, and R2. Results There were 808 patients who met inclusion criteria; 539 (66.7{\%}) had open and 269 (33.3{\%}) had laparoscopic PD. The CRS-PF was high risk in 134 patients, intermediate in 492, low in 135, and negligible in 47. Postoperative pancreatic fistula occurred in 191 (23.6{\%}) patients (grade A, 3.8{\%}; B, 14.2{\%}; and C, 5.6{\%}), and it increased with risk category (R2 = 0.935 all, 0.898 open, and 0.968 laparoscopic). High and intermediate risk categories were combined and classified as {"}test positive,{"} and negligible and low risk categories were combined and classified {"}test negative,{"} resulting in a CRS-PF with a sensitivity of 95{\%} and a negative predictive value of 96{\%} for predicting POPF. Contrary to previous studies, grade A POPF increased with increasing CRS-PF and POPF did not correlate with estimated blood loss (R2 = 0.04). Conclusions The CRS-PF was validated independently by predicting POPF for both laparoscopic and open PD. Predictive performance was at least as good for laparoscopic PD as for open PD. Lack of correlation with estimated blood loss suggests CRS-PF might be tailored for improved performance. The CRS-PF is a clinically useful tool for POPF risk stratification after PD and allows for targeted intra- and postoperative measures to address patients at increased risk.",
keywords = "Abbreviations and Acronyms CRS-PF clinical risk score for pancreatic fistula, EBL estimated blood loss, PD pancreatoduodenectomy, PF pancreatic fistula, POPF postoperative pancreatic fistula",
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T1 - Clinical Risk Score to Predict Pancreatic Fistula after Pancreatoduodenectomy

T2 - Independent External Validation for Open and Laparoscopic Approaches

AU - Shubert, Christopher R.

AU - Wagie, Amy E.

AU - Farnell, Michael B.

AU - Nagorney, David M.

AU - Que, Florencia

AU - Reid Lombardo, Kmarie

AU - Truty, Mark

AU - Smoot, Rory

AU - Kendrick, Michael L.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. Study Design The CRS-PF was calculated from a retrospective review of patients undergoing PD from January 2007 to February 2014. Postoperative pancreatic fistula was graded using International Study Group of Pancreatic Fistula criteria. Grade B and C leaks were defined as clinically significant. Performance was measured based on sensitivity, specificity, positive and negative predictive value, accuracy, and R2. Results There were 808 patients who met inclusion criteria; 539 (66.7%) had open and 269 (33.3%) had laparoscopic PD. The CRS-PF was high risk in 134 patients, intermediate in 492, low in 135, and negligible in 47. Postoperative pancreatic fistula occurred in 191 (23.6%) patients (grade A, 3.8%; B, 14.2%; and C, 5.6%), and it increased with risk category (R2 = 0.935 all, 0.898 open, and 0.968 laparoscopic). High and intermediate risk categories were combined and classified as "test positive," and negligible and low risk categories were combined and classified "test negative," resulting in a CRS-PF with a sensitivity of 95% and a negative predictive value of 96% for predicting POPF. Contrary to previous studies, grade A POPF increased with increasing CRS-PF and POPF did not correlate with estimated blood loss (R2 = 0.04). Conclusions The CRS-PF was validated independently by predicting POPF for both laparoscopic and open PD. Predictive performance was at least as good for laparoscopic PD as for open PD. Lack of correlation with estimated blood loss suggests CRS-PF might be tailored for improved performance. The CRS-PF is a clinically useful tool for POPF risk stratification after PD and allows for targeted intra- and postoperative measures to address patients at increased risk.

AB - Background A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. Study Design The CRS-PF was calculated from a retrospective review of patients undergoing PD from January 2007 to February 2014. Postoperative pancreatic fistula was graded using International Study Group of Pancreatic Fistula criteria. Grade B and C leaks were defined as clinically significant. Performance was measured based on sensitivity, specificity, positive and negative predictive value, accuracy, and R2. Results There were 808 patients who met inclusion criteria; 539 (66.7%) had open and 269 (33.3%) had laparoscopic PD. The CRS-PF was high risk in 134 patients, intermediate in 492, low in 135, and negligible in 47. Postoperative pancreatic fistula occurred in 191 (23.6%) patients (grade A, 3.8%; B, 14.2%; and C, 5.6%), and it increased with risk category (R2 = 0.935 all, 0.898 open, and 0.968 laparoscopic). High and intermediate risk categories were combined and classified as "test positive," and negligible and low risk categories were combined and classified "test negative," resulting in a CRS-PF with a sensitivity of 95% and a negative predictive value of 96% for predicting POPF. Contrary to previous studies, grade A POPF increased with increasing CRS-PF and POPF did not correlate with estimated blood loss (R2 = 0.04). Conclusions The CRS-PF was validated independently by predicting POPF for both laparoscopic and open PD. Predictive performance was at least as good for laparoscopic PD as for open PD. Lack of correlation with estimated blood loss suggests CRS-PF might be tailored for improved performance. The CRS-PF is a clinically useful tool for POPF risk stratification after PD and allows for targeted intra- and postoperative measures to address patients at increased risk.

KW - Abbreviations and Acronyms CRS-PF clinical risk score for pancreatic fistula

KW - EBL estimated blood loss

KW - PD pancreatoduodenectomy

KW - PF pancreatic fistula

KW - POPF postoperative pancreatic fistula

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