Risk Factors for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: A Single-Center Experience
Ahmed Reza Suny1, Sadia Islam2, Lokman Hossain3
1Department of Hepatobiliary Surgery, Dhaka Medical College Hospital, Dhaka, BGD.
Insights
Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) affects 28% of patients. Key predictors include soft pancreatic texture, small duct diameter, low albumin, high CRP, and long operative time.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Abdominal Surgery
Background:
- Postoperative pancreatic fistula (POPF) is a significant complication following pancreaticoduodenectomy (PD).
- POPF increases patient morbidity, prolongs hospital stays, and contributes to mortality.
- Understanding POPF predictors is crucial for improving patient outcomes after PD.
Purpose of the Study:
- To determine the incidence of POPF in a tertiary care setting in Bangladesh.
- To identify independent predictors of POPF following pancreaticoduodenectomy (PD).
Main Methods:
- Prospective observational study of 100 consecutive patients undergoing PD.
- Classification of patients into POPF and non-POPF groups using 2016 ISGPS criteria.
- Multivariate logistic regression analysis to identify independent POPF predictors.
Main Results:
- POPF incidence was 28%, with 18% being clinically relevant (Grade B/C).
- Independent predictors included soft pancreatic texture, pancreatic duct diameter < 3 mm, serum albumin < 32 g/L, CRP > 20 mg/L, and operative duration > 360 minutes.
- POPF patients experienced longer hospital stays and higher mortality rates, though mortality was multifactorial.
Conclusions:
- POPF is a frequent complication after PD with significant predictors.
- Preoperative optimization and surgical technique are key to reducing POPF incidence.
- Further multicenter studies are needed for validation of findings.
Background:
Postoperative pancreatic fistula (POPF) is a common and clinically significant complication following pancreaticoduodenectomy (PD), contributing to increased morbidity, prolonged hospitalization, and mortality. This study aimed to determine the incidence and independent predictors of POPF in a tertiary care setting in Bangladesh.
Methods:
This prospective observational study included 100 consecutive patients who underwent PD at Dhaka Medical College Hospital from January to December 2024. Patients were classified into POPF and non-POPF groups based on the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria. Preoperative, intraoperative, and postoperative variables were analyzed. Multivariate logistic regression was performed to identify independent predictors of POPF.
Results:
POPF occurred in 28% of patients, with clinically relevant POPF (Grade B/C) accounting for 18%. On multivariate analysis, soft pancreatic texture (adjusted OR: 5.21, 95% CI: 1.73-15.68), pancreatic duct diameter < 3 mm (adjusted OR: 4.36, 95% CI: 1.52-12.47), serum albumin < 32 g/L (adjusted OR: 3.02, 95% CI: 1.11-8.19), elevated CRP > 20 mg/L (adjusted OR: 2.94, 95% CI: 1.04-8.28), and operative duration > 360 minutes (adjusted OR: 2.76, 95% CI: 1.01-7.51) were independent predictors of POPF. Patients with POPF had longer hospital stay (18.6 ± 6.2 vs. 11.9 ± 4.1 days) and higher mortality (14.3% vs. 2.8%). However, mortality was likely multifactorial and not solely attributable to POPF.
Conclusion:
POPF remains a frequent complication after PD. Soft pancreatic texture, small duct diameter, hypoalbuminemia, elevated CRP, and prolonged operative time are significant independent predictors. Although POPF is associated with adverse postoperative outcomes, its relationship with mortality is likely indirect. Preoperative optimization and meticulous surgical technique may reduce POPF incidence and improve outcomes. Further multicenter studies are required for external validation.
