Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy

Table 1 Univariate analyses of risk factors for clinically relevant postoperative pancreatic fistula n (%)

Parameters	Non B/C grade POPF group (n = 832)	B/C grade POPF group (n = 89)	P value
Age (n = 921)
< 65 yr	640 (76.9)	68 (76.4)	0.91
≥ 65 yr	192 (23.1)	21 (23.6)
Sex (n = 921)
Male	529 (63.6)	62 (69.7)	0.26
Female	303 (36.4)	27 (30.3)
BMI (n = 921)3
< 28	773 (92.9)	71 (80.8)	0.00
≥ 28	59 (7.1)	18 (20.2)
Personal history
Hypertension (n = 921)
Yes	177 (21.3)	16 (18.0)	0.47
No	655 (78.7)	73 (82.0)
Diabetes mellitus (n = 921)
Yes	95 (11.4)	11 (12.4)	0.79
No	737 (88.6)	78 (87.6)
Coronary artery disease (n = 921)
Yes	81 (9.7)	4 (4.5)	0.54
No	781 (93.9)	85 (95.5)
Smoking (n = 921)
Yes	199 (23.9)	23 (25.8)	0.69
No	633 (76.1)	66 (74.2)
Drinking (n = 921)3
Yes	174 (20.9)	12 (13.5)	0.09
No	658 (79.1)	77 (86.5)
Abdominal operation history (n = 921)
Yes	111 (13.3)	14 (15.7)	0.53
No	721 (86.7)	75 (84.3)
Serum albumin (g/L, n = 893)
< 35	660 (81.8)	13 (15.1)	0.48
≥ 35	147 (18.2)	73 (84.9)
Serum total bilirubin (µmol/L, n = 905)1
< 171	604 (73.9)	61 (69.3)	0.40
≥ 171	213 (26.1)	27 (30.7)
Type of resection (n = 921)
PD	446 (53.6)	45 (50.6)	0.58
PPPD	386 (46.4)	44 (49.4)
Pancreatic duct (mm, n = 921)3
< 3	250 (30.0)	62 (69.7)	0.00
≥ 3	582 (70.0)	27 (30.3)
Texture of remnant pancreas (n = 921)3
Soft	289 (34.7)	68 (76.4)	0.00
Hard	543 (65.3)	21 (23.6)
Operative time (min, n = 913)
< 360	346 (42.0)	35 (39.3)	0.65
≥ 360	478 (58.0)	54 (60.7)
Difference between the blood loss and transfusion in operation (mL, n = 920)3
< 800	772 (92.9)	75 (84.3)	0.00
≥ 800	59 (7.1)	14 (15.7)
Reconstruction of blood vessels (n = 921)
Yes	29 (3.5)	2 (2.2)	0.76
No	803 (96.5)	87 (97.8)
Pancreaticoduodenectomy extending to adjacent (n = 921)2
Yes	21 (2.5)	0 (-)	0.25
No	786 (94.5)	89 (100.0)
Pancreatic carcinoma
Yes	219 (26.3)	15 (16.9)	0.05
No	613 (73.7)	74 (83.1)

¹This level of serum total bilirubin was assayed just before the operation (tested within three days before operation);

²Combined resection of adjacent organs including: liver, colon, kidney and so on;

³Statistically significant. POPF: Postoperative pancreatic fistula; PD: Pancreaticoduodenectomy; PPPD: Pylorus-preserving pancreaticoduodenectomy.

Table 2 Multivariate logistic regression models of independent risk factors for clinically relevant postoperative pancreatic fistula (n = 921)

	P value	OR	95%CI
BMI (≥ 28)	0.00	3.86	1.92-7.75
Pancreatic duct (< 3 mm)
≥ 5 mm		1.00
3-5 mm	0.00	4.59	2.47-8.53
2-3 mm	0.00	7.91	4.07-15.39
< 2 mm	0.00	8.97	3.70-21.77
Texture of remnant pancreas (soft)	0.00	4.50	2.53-7.98
Difference between the blood loss and transfusion in operation (≥ 800 mL)	0.00	3.45	1.92-7.75

BMI: Body mass index.

Table 3 Risk scoring system for clinically relevant postoperative pancreatic fistula

Risk factor	Points contributed
BMI (kg/m2)
< 28	0 point
≥ 28	1 point
Gland texture
Firm	0 point
Soft	1 point
The difference between the blood loss and transfusion in operation
< 800 mL	0 point
≥ 800 mL	1 point
Pancreatic duct diameter
≥ 5 mm	0 point
3-5 mm	1 point
2-3 mm	2 points
< 2 mm	3 points

BMI: Body mass index.