Clinical and Cost Profile of Controlled Grade B Postoperative Pancreatic Fistula: Rationale for Their Consideration...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Health Economics

Background:

• The 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria for postoperative pancreatic fistulas (POPFs) may oversimplify grade B classifications.
• Clinical and economic distinctions within grade B POPFs require further investigation.

Purpose of the Study:

• To evaluate the clinical and fiscal impact of the 2016 ISGPS criteria for POPFs.
• To refine grading criteria for grade B POPFs by assessing outcomes based on drainage requirements.

Main Methods:

• Retrospective analysis of pancreaticoduodenectomy cases (2008-2018) using NSQIP data.
• POPFs classified using 2016 ISGPS criteria; complication severity by Clavien-Dindo (CD) Classification.
• Sub-analysis of grade B POPFs based on drainage adequacy.

Main Results:

• Of 232 patients, 72 (31%) had POPFs: 16 biochemical leaks, 54 grade B, 2 grade C.
• Adequately drained grade B POPFs (92%) showed low morbidity (CD 1-2) and costs similar to no POPF.
• Grade B POPFs requiring additional drainage had higher morbidity (CD 3-4a), readmissions (67%), and increased costs (p=0.02).

Conclusions:

• The 2016 ISGPS criteria do not fully capture clinical and economic differences within POPF grades.
• Sub-analysis reveals adequately drained grade B POPFs are clinically insignificant.
• Refined criteria for grade B POPFs can better guide patient management and resource allocation.