Predictive Factors for Postoperative Pancreatic Fistula-A Swedish Nationwide Register-Based Study

• Background A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort. Methods Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF. Results A total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo >= 3a, 75% vs. 21%,p < 0.001) and longer hospital stay (median 23 [16-35] vs. 11 [8-15],p < 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08,p < 0.001). Preoperative presence of diabetes (OR 0.52,p = 0.012) and preoperative biliary drainage (OR 0.34,p < 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41,p < 0.001). Weight gain >= 2 kg on postoperative day 1 was also a risk factor (OR 1.76,p < 0.001). Conclusion A high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Keyword

international study-group

prospective-randomized-trial

pancreaticoduodenectomy

pancreaticojejunostomy

pancreaticogastrostomy

surgery

impact

reconstruction

complications

classification

Surgery

Publication and Content Type

ref (subject category)

art (subject category)