Predictive value of preoperative albumin-bilirubin score and other risk factors for short-term outcomes after open pancreatoduodenectomy

Table 1 Patient characteristics, n (%)

Patient characteristic	n = 347
Male gender	193 (55.6)
Age (yr), median (IQR)	69 (61-76)
BMI, median (IQR)	25.2 (22.5-28.4)
Bilirubin (µmol/L), median (IQR)	21 (10-84)
Albumin (g/L), median (IQR)	41 (38-44)
ALBI score, median (IQR)	-2.6 (-3.0 to -2.0)
ALBI grade
1	173 (50.3)
2	146 (42.4)
3	25 (7.3)
ASA score
1	10 (2.9)
2	136 (39.2)
3	197 (56.8)
4	4 (1.2)
Operation type
PPPD	175 (50.4)
Whipple	172 (49.6)
Pathology
Pancreatic carcinoma	170 (49.0)
Bile duct carcinoma	36 (10.4)
Duodenal carcinoma	9 (2.6)
Ampullary carcinoma	46 (13.6)
NET	27 (7.8)
IPMN	16 (4.6)
Other	43 (12.4)
Soft pancreatic texture, n (%) (n = 307)	164 (53.4)
Duct diameter (mm), median (IQR)	3 (3-5)
Anastomosis type
PJA duct to mucosa	241 (69.5)
PJA invagination	94 (27.1)
PGA	12 (3.5)
Blood loss (ml), median (IQR)	400 (300-563)
Somatostatin use	185 (53.3)
Length of hospitalization (d), median (IQR)	14 (10-23)
Clavien-Dindo
0	164 (47.3)
I	9 (2.6)
II	79 (22.8)
IIIa	18 (5.2)
IIIb	32 (9.2)
IV	27 (7.8)
V	18 (5.2)
Main reason of postoperative complications
No complications	164 (47.3)
Pancreatic fistula	66 (19.0)
Haemorrhage	20 (5.8)
Biliary fistula	13 (3.7)
Abscess	38 (11.0)
Other	52 (15.0)
Pancreatic fistula
0 and BL	264 (76.1)
B and C	83 (23.9)
Reoperation	74 (21.3)
Death	18 (5.2)

IQR: Interquartile range; BMI: Body mass index; ALBI: Albumin-bilirubin; ASA score: American Society of Anesthesiologists score; PPPD: Pylorus-preserving pancreatoduodenectomy; NET: Neuroendocrine tumour; IPMN: Intraductal papillary mucinous neoplasm; PJA: Pancreatico-jejunal anastomosis; PGA: Pancreatico-gastric anastomosis; BL: Biochemical leak.

Table 2 Factors associated with postoperative complications (univariate logistic regression), n (%)

	No postoperative complications (n = 164)	Postoperative complications (n = 183)	OR (95%CI)	P value
Male gender	81 (49.4)	112 (61.2)	1.62 (1.05-2.48)	0.027
Age (yr), median (IQR)	67 (60.5-74.5)	69 (63-76)	1.01 (0.99-1.03)	0.383
BMI, median (IQR)	24.6 (22.0-27.8)	25.4 (22.8-29.0)	1.06 (1.01-1.12)	0.014
ASA score				0.0191
1	8 (4.9)	2 (1.1)
2	66 (40.2)	70 (38.3)
3	90 (54.9)	107 (58.5)
4	0 (0)	4 (2.2)
ALBI score	-2.6 (-3.0 to -2.1)	-2.6 (-3.0 to -1.9)	1.14 (0.84-1.56)	0.404
Operation type
PPPD	88 (53.7)	87 (47.5)	1
Whipple	76 (46.3)	96 (52.5)	1.28 (0.84-1.95)	0.255
Somatostatin use	82 (50)	103 (56.3)	1.29 (0.84-1.97)	0.242
Soft pancreatic texture	60 (41.7)	104 (63.8)	2.47 (1.56-3.91)	< 0.001
Blood loss (mL), median (IQR)	400 (250-500)	400 (300-600)	1.05 (0.99-1.10)	0.088
Pathology
Pancreatic carcinoma	95 (57.9)	75 (41.0)	0.50 (0.33-0.77)	0.002
Bile duct carcinoma	12 (7.3)	24 (13.1)	1.91 (0.92-3.96)	0.081
Duodenal carcinoma	1 (0.6)	8 (4.4)	7.45 (0.92-60.23)	0.060
Ampullary carcinoma	21 (12.8)	25 (13.7)	1.08 (0.58-2.01)	0.814
NET	12 (7.3)	15 (8.2)	1.13 (0.51-2.49)	0.760
IPMN	8 (4.9)	8 (4.4)	0.89 (0.33-2.43)	0.822

¹Likelihood ratio test.

OR: Odds ratio; IQR: Interquartile range; BMI: Body mass index; ALBI: Albumin-bilirubin; ASA score: American Society of Anesthesiologists score; PPPD: Pylorus-preserving pancreatoduodenectomy; NET: Neuroendocrine tumour; IPMN: Intraductal papillary mucinous neoplasm.

Table 3 Factors associated with major postoperative complications (univariate logistic regression), n (%)

	No or minor postoperative complications (n = 252)	Major postoperative complications (n = 95)	OR (95%CI)	P value
Male gender	130 (51.6)	63 (66.3)	1.85 (1.13-3.02)	0.014
Age (yr), median (IQR)	68 (61-76)	69 (63-76)	1 (0.98-1.03)	0.698
BMI, median (IQR)	24.8 (22.3-27.9)	26.6 (23.1-29.8)	1.07 (1.02-1.13)	0.012
ASA score
1	9 (3.6)	1 (1.1)	1
2	98 (38.9)	38 (40)	3.49 (0.43-28.49)	0.243
3	144 (57.1)	53 (55.8)	3.31 (0.41-26.78)	0.261
4	1 (0.4)	3 (3.2)	27 (1.26-578.35)	0.035
ALBI score	-2.6 (-3.0 to -2.0)	-2.6 (-3.0 to -1.9)	1.26 (0.89-1.78)	0.188
Operation type
PPPD	131 (52)	44 (46.3)	1
Whipple	121 (48)	51 (53.7)	1.25 (0.78-2.01)	0.347
Somatostatin use	130 (51.6)	55 (57.9)	1.29 (0.80-2.08)	0.294
Soft pancreatic texture	103 (46.2)	61 (72.6)	3.09 (1.79-5.34)	< 0.001
Blood loss (mL), median (IQR)	400 (250-500)	400 (300-700)	1.08 (1.02-1.14)	0.005
Pathology
Pancreatic carcinoma	136 (54.0)	34 (35.8)	0.48 (0.29-0.77)	0.003
Bile duct carcinoma	22 (8.7)	14 (14.7)	1.81 (0.88-3.70)	0.105
Duodenal carcinoma	2 (0.8)	7 (7.4)	9.94 (2.03-48.77)	0.005
Ampullary carcinoma	36 (14.3)	10 (10.5)	0.71 (0.34-1.49)	0.359
NET	18 (7.1)	9 (9.5)	1.36 (0.59-3.14)	0.471
IPMN	11 (4.4)	5 (5.3)	1.22 (0.41-3.60)	0.722

OR: Odds ratio; IQR: Interquartile range; BMI: Body mass index; ALBI: Albumin-bilirubin; ASA score: American Society of Anesthesiologists score; PPPD: Pylorus-preserving pancreatoduodenectomy; NET: Neuroendocrine tumour; IPMN: Intraductal papillary mucinous neoplasm.

Table 4 Factors associated with postoperative pancreatic fistula (univariate logistic regression), n (%)

	No POPF (n = 264)	POPF (n = 83)	OR (95%CI)	P value
Male gender	140 (53)	53 (63.9)	1.56 (0.94-2.6)	0.085
Age (yr), median (IQR)	68 (61-75.5)	70 (64-76)	1.01 (0.99-1.03)	0.478
BMI, median (IQR)	24.8 (22.2-27.9)	26 (23.5-29.8)	1.08 (1.02-1.15)	0.008
ASA score
1	9 (3.4)	1 (1.2)	1
2	101 (38.3)	35 (42.2)	3.12 (0.38-25.51)	0.289
3	152 (57.6)	45 (54.2)	2.66 (0.33-21.6)	0.359
4	2 (0.8)	2 (2.4)	9 (0.52-155.24)	0.130
ALBI score	-2.6 (-3.0 to -2.0)	-2.6 (-3.0 to -1.9)	1.13 (0.78-1.62)	0.520
Operation type
PPPD	129 (48.9)	46 (55.4)	1
Whipple	135 (51.1)	37 (44.6)	0.77 (0.47-1.26)	0.298
Somatostatin use	135 (51.1)	50 (60.2)	1.45 (0.88-2.39)	0.148
Soft pancreatic texture	104 (44.4)	60 (82.2)	5.77 (3.00-11.08)	< 0.001
Blood loss (mL), median (IQR)	400 (250-560)	400 (300-600)	1.02 (0.98-1.05)	0.356
Pathology
Pancreatic carcinoma	144 (54.5)	26 (31.3)	0.38 (0.23-0.64)	< 0.001
Bile duct carcinoma	20 (7.6)	16 (19.3)	2.91 (1.43-5.93)	0.003
Duodenal carcinoma	3 (1.1)	6 (7.2)	6.78 (1.66-27.74)	0.008
Ampullary carcinoma	34 (12.9)	12 (14.5)	1.14 (0.56-2.33)	0.712
NET	20 (7.6)	7 (8.4)	1.12 (0.46-2.76)	0.799
IPMN	11 (4.2)	5 (6.0)	1.47 (0.50-4.37)	0.484

POPF: Postoperative pancreatic fistula; OR: Odds ratio; IQR: Interquartile range; BMI: Body mass index; ALBI: Albumin-bilirubin; ASA score: American Society of Anesthesiologists score; PPPD: Pylorus-preserving pancreatoduodenectomy; NET: Neuroendocrine tumour; IPMN: Intraductal papillary mucinous neoplasm.

Table 5 Factors associated with reoperation (univariate logistic regression), n (%)

	No reoperation (n = 273)	Reoperation (n = 74)	OR (95%CI)	P value
Male gender	143 (52.4)	50 (67.6)	1.89 (1.10-3.26)	0.021
Age (yr), median (IQR)	68 (61-75)	70.5 (63-76)	1.02 (0.99-1.04)	0.192
BMI, median (IQR)	24.9 (22.4-27.9)	26.1 (22.8-30.1)	1.07 (1.01-1.14)	0.018
ASA score
1	9 (3.3)	1 (1.4)	1
2	108 (39.6)	28 (37.8)	2.33 (0.28-19.2)	0.431
3	155 (56.8)	42 (56.8)	2.44 (0.30-19.79)	0.404
4	1 (0.4)	3 (4.1)	27 (1.26-578.35)	0.035
ALBI score	-2.6 (-3.0 to -2.0)	-2.7 (-3.0 to -1.7)	1.27 (0.87-1.85)	0.211
Operation type
PPPD	144 (52.7)	31 (41.9)	1
Whipple	129 (47.3)	43 (58.1)	1.55 (0.92-2.60)	0.099
Somatostatin use	142 (52)	43 (58.1)	1.28 (0.76-2.15)	0.352
Soft pancreatic texture	114 (47.5)	50 (74.6)	3.25 (1.77-5.96)	< 0.001
Blood loss (mL), median (IQR)	400 (250-500)	400 (300-800)	1.07 (1.02-1.13)	0.007
Pathology
Pancreatic carcinoma	144 (52.7)	26 (35.1)	0.49 (0.28-0.83)	0.008
Bile duct carcinoma	28 (10.3)	8 (10.8)	1.06 (0.46-2.44)	0.890
Duodenal carcinoma	3 (1.1)	6 (8.1)	7.94 (1.94-32.57)	0.004
Ampullary carcinoma	36 (13.2)	10 (13.5)	1.03 (0.48-2.18)	0.941
NET	20 (7.3)	7 (9.5)	1.32 (0.54-3.26)	0.544
IPMN	11 (4.0)	5 (6.8)	1.73 (0.58-5.13)	0.326

OR: Odds ratio; IQR: Interquartile range; BMI: Body mass index; ALBI: Albumin-bilirubin; ASA score: American Society of Anesthesiologists score; PPPD: Pylorus-preserving pancreatoduodenectomy; NET: Neuroendocrine tumour; IPMN: Intraductal papillary mucinous neoplasm.

Table 6 Factors associated with postoperative mortality (univariate logistic regression), n (%)

	Survived (n = 329)	Died (n = 18)	OR (95%CI)	P value
Male gender	182 (55.3)	11 (61.1)	1.27 (0.48-3.36)	0.631
Age (yr), median (IQR)	68 (61-75)	75.5 (69-82)	1.07 (1.01-1.14)	0.015
BMI, median (IQR)	25 (22.5-28.4)	27.7 (24.9-29.7)	1.07 (0.96-1.19)	0.223
ASA score				0.5201
1	10 (3)	0 (0)
2	129 (39.2)	7 (38.9)
3	188 (57.1)	9 (50.0)
4	2 (0.6)	2 (11.1)
ALBI score	-2.6 (-3.0 to -2.0)	-2.8 (-3.1 to -1.8)	1.18 (0.59-2.34)	0.639
Operation type
PPPD	168 (51.1)	7 (38.9)	1
Whipple	161 (48.9)	11 (61.1)	1.64 (0.62-4.33)	0.319
Somatostatin use	178 (54.1)	7 (38.9)	0.54 (0.20-1.43)	0.214
Soft pancreatic texture	152 (52.2)	12 (75.0)	2.74 (0.86-8.71)	0.087
Blood loss (mL), median (IQR)	400 (250-500)	600 (400-1000)	1.07 (1.02-1.13)	0.007
Pathology
Pancreatic carcinoma	164 (49.8)	6 (33.3)	0.50 (0.18-1.37)	0.180
Bile duct carcinoma	32 (9.7)	4 (22.2)	2.65 (0.82-8.54)	0.102
Duodenal carcinoma	9 (2.7)	0 (0)		0.324*
Ampullary carcinoma	42 (12.8)	4 (22.2)	1.95 (0.61-6.21)	0.257
NET	26 (7.9)	1 (5.6)	0.69 (0.09-5.36)	0.719
IPMN	15 (4.6)	1 (5.6)	1.23 (0.15-9.88)	0.845

¹Likelihood ratio test.

OR: Odds ratio; IQR: Interquartile range; BMI: Body mass index; ALBI: Albumin-bilirubin; ASA score: American Society of Anesthesiologists score; PPPD: Pylorus-preserving pancreatoduodenectomy; NET: Neuroendocrine tumour; IPMN: Intraductal papillary mucinous neoplasm.

Table 7 Association between risk factors and logarithmized length of hospitalization (multiple linear regression)

	Regression coefficient (SE)	P value
(Constant)	2.54 (0.44)	< 0.001
Male gender	0.12 (0.08)	0.129
Age	0 (0)	0.337
BMI	0.02 (0.01)	0.026
ASA 3 vs ASA 1 or 2	-0.03 (0.08)	0.755
ASA 4 vs ASA 1 or 2	-0.26 (0.55)	0.633
ALBI score	0.12 (0.06)	0.050
PPPD vs Whipple	0.12 (0.08)	0.127
Somatostatin use	-0.09 (0.08)	0.228
Soft pancreatic texture	0.08 (0.09)	0.342
Blood loss	0 (0)	0.144
Pathology
Pancreatic carcinoma	-0.44 (0.12)	< 0.001
Bile duct carcinoma	-0.17 (0.16)	0.280
Duodenal carcinoma	0.69 (0.25)	0.006
Ampullary carcinoma	-0.41 (0.14)	0.004
NET	0.09 (0.18)	0.620
IPMN	-0.54 (0.21)	0.012

SE: Standard error; BMI: Body mass index; ALBI: Albumin-bilirubin; ASA score: American Society of Anesthesiologists score; PPPD: Pylorus-preserving pancreatoduodenectomy; NET: Neuroendocrine tumour; IPMN: Intraductal papillary mucinous neoplasm.

Table 8 Association between risk factors and short-term postoperative outcomes (multiple logistic regression)

	Postoperative complications		Major postoperative complications		POPF		Reoperation
	OR (95%CI)	P value	OR (95% CI)	P value	OR (95% CI)	P value	OR (95% CI)	P value
Male gender	1.63 (0.97-2.75)	0.066	2.12 (1.15-3.93)	0.016	1.75 (0.92-3.33)	0.090	1.97 (1.01-3.83)	0.046
Age (yr)	1.01 (0.98-1.04)	0.435	1.01 (0.98-1.04)	0.621	1.02 (0.99-1.06)	0.177	1.02 (0.99-1.05)	0.265
BMI	1.04 (0.98-1.11)	0.161	1.06 (0.98-1.13)	0.124	1.07 (0.99-1.15)	0.090	1.06 (0.98-1.14)	0.160
ASA 3 or 4	0.91 (0.53-1.57)	0.740	0.69 (0.38-1.28)	0.240	0.60 (0.31-1.17)	0.135	0.73 (0.38-1.41)	0.351
ALBI score	1.22 (0.82-1.82)	0.323	1.30 (0.83-2.04)	0.245	1.23 (0.76-1.99)	0.390	1.38 (0.85-2.22)	0.190
Soft pancreatic texture	2.09 (1.19-3.67)	0.011	3.06 (1.56-5.97)	0.001	5.11 (2.38-10.95)	< 0.001	2.95 (1.42-6.11)	0.004
Blood loss	1.03 (0.97-1.09)	0.283	1.07 (1-1.14)	0.045	1.00 (0.96-1.05)	0.908	1.08 (1.01-1.16)	0.022
Pathology
Pancreatic carcinoma	0.68 (0.38-1.21)	0.187	0.76 (0.39-1.48)	0.417	0.77 (0.37-1.59)	0.477	0.70 (0.34-1.46)	0.345
Duodenal carcinoma	3.32 (0.39-28.63)	0.274	5.06 (0.93-27.66)	0.061	2.99 (0.64-13.95)	0.164	6.58 (1.2-36.15)	0.030

POPF: Postoperative pancreatic fistula; OR: Odds ratio; BMI: Body mass index; ALBI: Albumin-bilirubin; ASA score: American Society of Anesthesiologists score.