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

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    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 - Nov 1 2014

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    Pancreatic Fistula
    Pancreatectomy
    Amylases
    Drainage
    Pancreaticoduodenectomy
    Pancreatic Ducts
    Quality Improvement
    Reoperation
    ROC Curve
    Fistula
    Body Mass Index
    Databases

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

    Lee, C. W., Pitt, H. A., Riall, T. S., Ronnekleiv-Kelly, S. S., Israel, J. S., Leverson, G. E., ... 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

    Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. / Lee, Christina W.; Pitt, Henry A.; Riall, Taylor S.; Ronnekleiv-Kelly, Sean S.; Israel, Jacqueline S.; Leverson, Glen E.; Parmar, Abhishek D.; Kilbane, E. Molly; Hall, Bruce L.; Weber, Sharon M.

    In: Journal of Gastrointestinal Surgery, Vol. 18, No. 11, 01.11.2014, p. 1902-1910.

    Research output: Contribution to journalArticle

    Lee, CW, Pitt, HA, Riall, TS, Ronnekleiv-Kelly, SS, Israel, JS, Leverson, GE, Parmar, AD, Kilbane, EM, Hall, BL & Weber, SM 2014, 'Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy', Journal of Gastrointestinal Surgery, vol. 18, no. 11, pp. 1902-1910. https://doi.org/10.1007/s11605-014-2601-6
    Lee CW, Pitt HA, Riall TS, Ronnekleiv-Kelly SS, Israel JS, Leverson GE et al. Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. Journal of Gastrointestinal Surgery. 2014 Nov 1;18(11):1902-1910. https://doi.org/10.1007/s11605-014-2601-6
    Lee, Christina W. ; Pitt, Henry A. ; Riall, Taylor S. ; Ronnekleiv-Kelly, Sean S. ; Israel, Jacqueline S. ; Leverson, Glen E. ; Parmar, Abhishek D. ; Kilbane, E. Molly ; Hall, Bruce L. ; Weber, Sharon M. / Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. In: Journal of Gastrointestinal Surgery. 2014 ; Vol. 18, No. 11. pp. 1902-1910.
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    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.",
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    AU - Lee, Christina W.

    AU - Pitt, Henry A.

    AU - Riall, Taylor S.

    AU - Ronnekleiv-Kelly, Sean S.

    AU - Israel, Jacqueline S.

    AU - Leverson, Glen E.

    AU - Parmar, Abhishek D.

    AU - Kilbane, E. Molly

    AU - Hall, Bruce L.

    AU - Weber, Sharon M.

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    N2 - 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.

    AB - 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.

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