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Updated: Jun 23, 2025
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Published on: March 12, 2019
A Comparison of Preoperative Predictive Scoring Systems for Postoperative Pancreatic Fistula after
Naomi Verdeyen1, Filip Gryspeerdt2, Luìs Abreu de Carvalho2
1Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium.
Insights
Comparing risk scores for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is crucial. The Fistula Risk Score (FRS) demonstrated superior predictive accuracy, with a modified preoperative FRS showing promise for high-risk patient identification.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Postoperative pancreatic fistula (POPF) is a significant complication following pancreaticoduodenectomy (PD), leading to increased morbidity and mortality.
- Several scoring systems exist to predict POPF risk, aiding in patient management.
- This study aimed to compare the efficacy of various preoperative and intraoperative scoring systems for POPF prediction in PD patients.
Purpose of the Study:
- To compare the predictive accuracy of established preoperative risk scores and the intraoperative Fistula Risk Score (FRS) for POPF.
- To evaluate a modified FRS, excluding blood loss (BL), for its preoperative predictive performance.
- To identify independent prognostic factors for POPF in patients undergoing PD.
Main Methods:
- Analysis of 196 patients who underwent PD between July 2019 and June 2022.
- Inclusion of four validated preoperative risk scores and the intraoperative FRS.
- Development of a modified FRS by removing the blood loss variable.
- Statistical analysis including univariate, multivariate, and ROC analyses to compare scoring systems.
Main Results:
- All evaluated scoring systems demonstrated significant prognostic stratification for POPF (p < 0.001).
- The intraoperative FRS exhibited the highest overall predictive accuracy (AUC 0.862).
- The FRS without blood loss (BL) showed the best predictive value among preoperative scores (AUC 0.783).
- Soft pancreatic texture, male gender, and Wirsung duct diameter were identified as independent predictors of POPF.
Conclusions:
- While all scoring systems accurately stratify POPF risk, preoperative assessment is vital for clinical decision-making.
- The modified FRS, utilized preoperatively, presents a viable alternative for identifying high-risk patients.
- Implementing preventive strategies based on preoperative risk stratification can improve patient outcomes after PD.
Abstract:
Background: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is associated with major postoperative morbidity and mortality. Several scoring systems have been described to stratify patients into risk groups according to the risk of POPF. The aim of this study was to compare scoring systems in patients who underwent a PD. Methods: A total of 196 patients undergoing PD from July 2019 to June 2022 were identified from a prospectively maintained database of the University Hospital Ghent. After performing a literature search, four validated, solely preoperative risk scores and the intraoperative Fistula Risk Score (FRS) were included in our analysis. Furthermore, we eliminated the variable blood loss (BL) from the FRS and created an additional score. Univariate and multivariate analyses were performed for all risk factors, followed by a ROC analysis for the six scoring systems. Results: All scores showed strong prognostic stratification for developing POPF (p < 0.001). FRS showed the best predictive accuracy in general (AUC 0.862). FRS without BL presented the best prognostic value of the scores that included solely preoperative variables (AUC 0.783). Soft pancreatic texture, male gender, and diameter of the Wirsung duct were independent prognostic factors on multivariate analysis. Conclusions: Although all predictive scoring systems stratify patients accurately by risk of POPF, preoperative risk stratification could improve clinical decision-making and implement preventive strategies for high-risk patients. Therefore, the preoperative use of the FRS without BL is a potential alternative.
