期刊
HPB
卷 24, 期 8, 页码 1252-1260出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.hpb.2021.12.017
关键词
-
资金
- American College of Surgeons as part of the Clinical Scholars in Residence program
- National Cancer Institute [T32CA247801]
This study evaluated the association of postoperative hyperamylasemia (POHA) grade with clinically relevant postoperative pancreatic fistula (CR-POPF) and compared its prognostic utility against postoperative day 1 drain fluid amylase (DFA-1). The study found that POHA grade is associated with CR-POPF and outperforms DFA-1 in predicting its occurrence.
Background: The clinical importance of postoperative hyperamylasemia (POHA) grade is unknown. Our objectives were to evaluate the association of POHA grade with clinically relevant postoperative pancreatic fistula (CR-POPF) and compare its prognostic utility against postoperative day 1 drain fluid amylase (DFA-1). Methods: Patients who underwent pancreatectomy from January 2019 through March 2020 were identified in the ACS NSQIP pancreatectomy-targeted dataset. POHA grade was assigned using post-operative serum amylase and clinical sequelae. The primary outcome was CR-POPF within 30 days. The association of POHA grade with CR-POPF was assessed using multivariable logistic regression, and c-statistics were used to compare POHA grade versus DFA-1. Results: POHA occurred in 520 patients at 98 hospitals, including 261 (50.2%) with grade A, 234 (45.0%) with grade B, and 25 (4.8%) with grade C POHA. CR-POPFs were increased among patients with grade B (66.2%, OR 9.28 [5.84-14.73]) and C (68.0%, OR 10.50 [3.77-29.26]) versus grade A POHA (19.2%). POHA-inclusive models better predicted CR-POPF than those with DFA-1 alone (p < 0.002) and models with both predictors outperformed POHA alone (p = 0.039). Conclusion: POHA grade represents a measure of post-pancreatectomy outcomes that predicts CRPOPF and outperforms DFA-1 but must be aligned with new international definitions.
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