Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy

Christina W. Lee, Henry A. Pitt, Taylor S. Riall, Sean S. Ronnekleiv-Kelly, Jacqueline S. Israel, Glen E. Leverson, Abhishek D. Parmar, E. Molly Kilbane, Bruce L. Hall, Sharon M. Weber

    Research output: Contribution to journalArticle

    36 Scopus citations

    Abstract

    Introduction: Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out.

    Methods: Patients undergoing pancreatic resection from November 1, 2011 to December 31, 2012 were selected from the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project database. Pancreatic fistula was defined as drainage of amylase-rich fluid with drain continuation >7 days, percutaneous drainage, or reoperation for a pancreatic fluid collection. Univariate and multi-variable regression models were utilized to identify factors predictive of pancreatic fistula.

    Results: DFA1 was recorded in 536 of 2,805 patients who underwent pancreatic resection, including pancreaticoduodenectomy (n = 380), distal pancreatectomy (n = 140), and enucleation (n = 16). Pancreatic fistula occurred in 92/536 (17.2 %) patients. DFA1, increased body mass index, small pancreatic duct size, and soft texture were associated with fistula (p < 0.05). A DFA1 cutoff value of <90 U/L demonstrated the highest negative predictive value of 98.2 %. Receiver operating characteristic (ROC) curve confirmed the predictive relationship of DFA1 and pancreatic fistula.

    Conclusion: Low DFA1 predicts the absence of a pancreatic fistula. In patients with DFA1 < 90 U/L, early drain removal is advisable.

    Original languageEnglish (US)
    Pages (from-to)1902-1910
    Number of pages9
    JournalJournal of Gastrointestinal Surgery
    Volume18
    Issue number11
    DOIs
    StatePublished - 2014

    Keywords

    • American College of Surgeons-National Surgical Quality Improvement Program
    • Drain fluid amylase
    • Pancreatectomy
    • Pancreatic fistula

    ASJC Scopus subject areas

    • Surgery
    • Gastroenterology

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  • Cite this

    Lee, C. W., Pitt, H. A., Riall, T. S., Ronnekleiv-Kelly, S. S., Israel, J. S., Leverson, G. E., Parmar, A. D., Kilbane, E. M., Hall, B. L., & Weber, S. M. (2014). Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy. Journal of Gastrointestinal Surgery, 18(11), 1902-1910. https://doi.org/10.1007/s11605-014-2601-6