Comparison of risk adjusted excess post-operative pancreatic fistula rates after pancreaticoduodenectomy using cumulative sum analysis

Lockie, EB; Knowles, B; Gill, PK; Thomson, B; Loveday, BPT

Author(s): Lockie, EB; Knowles, B; Gill, PK; Thomson, B; Loveday, BPT;
Details: Publication Year 2022-07,Volume 92,Issue #7-8,Page 1784-1788
Journal Title: ANZ Journal of Surgery
Publication Type: Research article
Abstract: BACKGROUND: Post-operative pancreatic fistula (POPF) is a key outcome post pancreaticoduodenectomy. There are numerous POPF risk calculators but no agreed benchmark, a key component of meaningful audit. We compared observed versus predicted POPF for six risk adjusted POPF calculators, to ascertain how they differ and thus contribute to discussion around benchmarking. METHODS: This was a retrospective single-arm cohort study at the Royal Melbourne Hospital of patients who underwent pancreaticoduodenectomy 1 November 2015 to 31 December 2021 with a primary outcome of a clinically relevant POPF. Cumulative sum (CUSUM) plots of observed versus predicted rate of POPF for sequential patients were constructed for six risk adjusted POPF calculators - Birmingham, updated Birmingham, fistula risk score (FRS), modified FRS (m-FRS), alternative FRS (a-FRS), and updated alternative FRS (ua-FRS). RESULTS: The study included 77 patients. The actual rate of clinically relevant POPF was 14.3%. FRS calculated an excess of 1.3 POPF per 100 cases. All other calculators demonstrated prevention of POPF per 100 cases: Birmingham 3.4, updated Birmingham 14.0, m-FRS 0.3, a-FRS 1.2, ua-FRS 19.7. CONCLUSION: The observed versus predicted rate of POPF was near zero for all risk calculators except ua-FRS and updated Birmingham, which predicted a higher POPF than observed (19.7, 14.0, respectively). These results indicate that, excepting ua-FRS and updated Birmingham, these calculators yield comparable results. Benchmarks for POPF should prescribe which risk calculators are used, and ideally a unified standard between centres should be the goal to provide consistency in outcome reporting and robust audit processes.
Publisher: Wiley
Keywords: Cohort Studies; Humans; *Pancreatic Fistula/epidemiology/etiology/prevention & control; *Pancreaticoduodenectomy/adverse effects/methods; Postoperative Complications/epidemiology/surgery; Retrospective Studies; Risk Assessment/methods; Risk Factors; benchmarking; clinical audit; pancreatic fistula; pancreaticoduodenectomy; risk assessment
Department(s): Surgical Oncology
PubMed ID: 35579055
Publisher's Version: https://doi.org/10.1111/ans.17770
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-01-24 05:57:02

Last Modified: 2025-01-24 05:58:22