External Validation of the Auditing Fistula Risk Score for Pancreatoduodenectomy

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Clinical Risk Prediction

Background:

• Postoperative pancreatic fistula (POPF) is a common complication following pancreatoduodenectomy (PD), occurring in 10%-25% of cases.
• Accurate risk stratification is crucial for optimizing patient outcomes and managing surgical complications.

Purpose of the Study:

• To validate the recently developed Auditing Fistula Risk Score (Auditing-FRS).
• To assess the performance of the Auditing-FRS in predicting POPF across different surgical approaches (open, laparoscopic, robotic).

Main Methods:

• Analysis of 25,250 PD cases from the 2015-2023 National Surgical Quality Improvement Program (NSQIP) database.
• Multivariable logistic regression to identify independent predictors of POPF.
• Evaluation of discrimination (AUC) and calibration (Brier score), and clinical utility (DCA) across operative subgroups.

Main Results:

• POPF occurred in 12.6% of the analyzed PD cases.
• The Auditing-FRS demonstrated good predictive performance with an overall AUC of 0.694, consistent across open, laparoscopic, and robotic procedures.
• Decision-curve analysis confirmed the clinical utility of Auditing-FRS for risk stratification within relevant thresholds.

Conclusions:

• The Auditing-FRS is a validated tool with acceptable discrimination and good calibration for predicting POPF after PD.
• The score is applicable across open, laparoscopic, and robotic pancreatoduodenectomy approaches.
• Auditing-FRS supports institutional benchmarking and perioperative risk stratification for patients undergoing PD.