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• W3044596422 abstract "Presenter: Conrad Blunck | University of Alabama - Birmingham Background: Post-operative pancreatic fistulae (POPF) are common complications following pancreatic resection and contribute substantially to increased perioperative morbidity. Traditionally, post-operative drain fluid amylase (DFA) concentration has been used to define POPF. Various DFA concentration thresholds have been proposed as predictors of safe post-operative drain removal. The aim of this study was to assess whether adjusting DFA for volume and time (vDFA) served as a better independent predictor of POPF than conventional DFA measurement since post-operative fluid shifts could theoretically dilute drain effluent and artificially decreased DFA. Methods: A retrospective cohort study of patients who underwent elective pancreatic resections between 2013 and 2019 was performed. Patient clinicopathologic data, POPF status, and DFA values were collected. All grades of POPF, as defined in the 2016 ISGPS consensus guidelines, were included as endpoints. vDFA was determined by multiplying DFA by the volume of total effluent during sample collection divided by the time since last collection. Receiver operator characteristic (ROC) analyses were used to determine the discriminatory ability of DFA and vDFA to correctly diagnosis POPF. Logistic regression was used to evaluate the prognostic ability of the DFA cutoff values, generated by Youdens estimation of the ROC curves, in predicting POPF. Results: There were 248 patients undergoing pancreatic resection during the study period with 43 (17%) developing a POPF. The value of the first post-operative DFA checked had similar discriminatory ability to diagnose a POPF compared to the corresponding vDFA (Fig1). To adjust for variances in timing of first checked amylase, DFA and vDFA values were stratified into 0-48, 49-96, and >97 hour cohorts. DFA and vDFA were not statistically different from each other in the ability to diagnose POPF except in the >97 hour cohort (AUC: DFA = 0.835, vDFA = 0.770; p = 0.020). ROC curve generated optimal cutoff values of DFA correctly predicting POPF for the first recorded DFA value, 0-48, 49-96, and >97 hour cohorts were 353, 1091, 484, and 152 U/L respectively. DFA greater than these respective cutoffs were associated with 12 [95%CI 6-26], 126 [95%CI 7-2328], 9 [95%CI 4-23], and 37 [95%CI 4-378] fold increased risk of developing a POPF by logistic regression. ROC curves using only volume as the predictive variable under the same aforementioned time cohorts was found to have worse discrimination for POPF than DFA. Conclusion: Drain fluid volume nor adjusting DFA for volume over time is more predictive of POPF development after pancreatic resection than standard DFA analysis." @default.
• W3044596422 created "2020-07-29" @default.
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• W3044596422 date "2020-01-01" @default.
• W3044596422 modified "2023-10-16" @default.
• W3044596422 title "Adjusting drain fluid amylase concentration for effluent volume does not add discriminatory value in predicting post-operative pancreatic fistula formation" @default.
• W3044596422 doi "https://doi.org/10.1016/j.hpb.2020.04.659" @default.
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