An easy-to-use score to predict clinically relevant postoperative pancreatic fistula after distal pancreatectomy

Postoperative pancreatic fistula (POPF) is a common and serious complication after distal pancreatectomy (DP). An effective and accepted score to predict the occurrence of clinically relevant (CR-) postoperative pancreatic fistula (POPF) does not exist.

Data regarding 103 consecutive patients undergoing DP from 2015 to 2019 were collected. A multivariate logistic regression was performed, in order to build a simplified score. The accuracy in predicting a categorical outcome was evaluated using the receiver operating characteristic (ROC) curves. Youden's J test was performed to evaluate the performance of a positive score on the POPF occurrence.

Thirty-three patients developed a CR-POPF. Based on multivariate analysis results, a 4 points score was created by assigning 1 point if operation time was >4 hours, amylase levels on drains' fluid >500 UI on POD 3, pancreatic thickness >10 mm and if the BMI was >30. The discriminating ability was tested on the ROC curve, showing an area under the curve of 0.83 (95% CI: 0.75-0.92). The score threshold was determined at 2 points/4, the highest value according to the Youden Index (0.53). The sensitivity is calculated at 82% (95% CI: 69-95) and the specificity at 71 (95% CI: 61-82). A threshold of 3 points/4 allows to reach a specificity of 99% (95% CI: 99-100).

An easy-to-use postoperative score based on operation time, obesity, amylase level on drains on POD3 and pancreatic thickness on preoperative CT seems to predict the risk of developing CR-POPF.