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Alternative fistula risk score for pancreatoduodenectomy (a-FRS): Design and international external validation

Alternative fistula risk score for pancreatoduodenectomy (a-FRS): Design and international external validation
Alternative fistula risk score for pancreatoduodenectomy (a-FRS): Design and international external validation

Objective: the aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor.

Background: blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations.

Methods: the a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS.

Results: for model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05).

Conclusions: the a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.

Aged, Female, Humans, Internationality, Male, Middle Aged, Pancreatic Fistula/epidemiology, Pancreaticoduodenectomy, Postoperative Complications/epidemiology, Risk Assessment/methods
0003-4932
937-943
Mungroop, Timothy H.
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van Rijssen, L. Bengt
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van Klaveren, David
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Smits, F. Jasmijn
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van Woerden, Victor
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Linnemann, Ralph J.
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de Pastena, Matteo
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Klompmaker, Sjors
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Marchegiani, Giovanni
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Ecker, Brett L.
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van Dieren, Susan
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van der Harst, Erwin
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de Hingh, Ignace H.
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de Jong, Koert P.
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Kazemier, Geert
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Luyer, Misha
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Shamali, Awad
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Barbaro, Salvatore
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Armstrong, Thomas
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Takhar, Arjun
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Hamady, Zaed
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Klaase, Joost
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Lips, Daan J.
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Molenaar, I. Quintus
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Nieuwenhuijs, Vincent B.
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Rupert, Coen
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van Santvoort, Hjalmar C.
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Scheepers, Joris J.
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van der Schelling, George P.
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Bassi, Claudio
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Vollmer, Charles M.
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Steyerberg, Ewout W.
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Abu Hilal, Mohammed
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Groot Koerkamp, Bas
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Besselink, Marc G.
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Dutch Pancreatic Cancer Group
Mungroop, Timothy H.
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van Rijssen, L. Bengt
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van Klaveren, David
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Smits, F. Jasmijn
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van Woerden, Victor
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Linnemann, Ralph J.
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de Pastena, Matteo
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Klompmaker, Sjors
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Marchegiani, Giovanni
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Ecker, Brett L.
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van Dieren, Susan
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Bonsing, Bert
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Busch, Olivier R.
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van Dam, Ronald M.
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van Eijck, Casper H.
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Luyer, Misha
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Shamali, Awad
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Barbaro, Salvatore
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Armstrong, Thomas
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Takhar, Arjun
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Hamady, Zaed
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Klaase, Joost
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Lips, Daan J.
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van Santvoort, Hjalmar C.
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Bassi, Claudio
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Vollmer, Charles M.
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Steyerberg, Ewout W.
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Abu Hilal, Mohammed
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Groot Koerkamp, Bas
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Besselink, Marc G.
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Mungroop, Timothy H., van Rijssen, L. Bengt and van Klaveren, David , Dutch Pancreatic Cancer Group (2019) Alternative fistula risk score for pancreatoduodenectomy (a-FRS): Design and international external validation. Annals of Surgery, 269 (5), 937-943. (doi:10.1097/SLA.0000000000002620).

Record type: Article

Abstract

Objective: the aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor.

Background: blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations.

Methods: the a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS.

Results: for model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05).

Conclusions: the a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.

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Published date: May 2019
Keywords: Aged, Female, Humans, Internationality, Male, Middle Aged, Pancreatic Fistula/epidemiology, Pancreaticoduodenectomy, Postoperative Complications/epidemiology, Risk Assessment/methods

Identifiers

Local EPrints ID: 485422
URI: http://eprints.soton.ac.uk/id/eprint/485422
DOI: doi:10.1097/SLA.0000000000002620
ISSN: 0003-4932
PURE UUID: ffd14194-d818-4b3b-8828-735f0b859e5b
ORCID for Zaed Hamady: ORCID iD orcid.org/0000-0002-4591-5226

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Date deposited: 06 Dec 2023 17:38
Last modified: 18 Mar 2024 04:05

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Contributors

Author: Timothy H. Mungroop
Author: L. Bengt van Rijssen
Author: David van Klaveren
Author: F. Jasmijn Smits
Author: Victor van Woerden
Author: Ralph J. Linnemann
Author: Matteo de Pastena
Author: Sjors Klompmaker
Author: Giovanni Marchegiani
Author: Brett L. Ecker
Author: Susan van Dieren
Author: Bert Bonsing
Author: Olivier R. Busch
Author: Ronald M. van Dam
Author: Joris Erdmann
Author: Casper H. van Eijck
Author: Michael F Gerhards
Author: Harry van Goor
Author: Erwin van der Harst
Author: Ignace H. de Hingh
Author: Koert P. de Jong
Author: Geert Kazemier
Author: Misha Luyer
Author: Awad Shamali
Author: Salvatore Barbaro
Author: Thomas Armstrong
Author: Arjun Takhar
Author: Zaed Hamady ORCID iD
Author: Joost Klaase
Author: Daan J. Lips
Author: I. Quintus Molenaar
Author: Vincent B. Nieuwenhuijs
Author: Coen Rupert
Author: Hjalmar C. van Santvoort
Author: Joris J. Scheepers
Author: George P. van der Schelling
Author: Claudio Bassi
Author: Charles M. Vollmer
Author: Ewout W. Steyerberg
Author: Mohammed Abu Hilal
Author: Bas Groot Koerkamp
Author: Marc G. Besselink
Corporate Author: Dutch Pancreatic Cancer Group

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