TY - JOUR
T1 - Predicting Successful Catheter Drainage in Patients with Pancreatic Fistula after Pancreatoduodenectomy
AU - Smits, F. Jasmijn
AU - van Santvoort, Hjalmar C.
AU - Besselink, Marc G.
AU - Boerma, Djamila
AU - Busch, Olivier R.
AU - van Dam, Ronald M.
AU - van Eijck, Casper H.
AU - Festen, Sebastiaan
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - de Jong, Koert P.
AU - Borel Rinkes, Inne H.
AU - Molenaar, I. Quintus
PY - 2019
Y1 - 2019
N2 - The objective of this study was to identify predictors for successful minimally invasive catheter drainage (ie, survival without relaparotomy) for pancreatic fistula after pancreatoduodenectomy. Methods Included were consecutive patients undergoing catheter drainage as first intervention for pancreatic fistula after pancreatoduodenectomy (2005-2013) in 9 Dutch centers. Possible prognostic factors for successful catheter drainage (ie, survival without relaparotomy) were selected using Akaike information criterion. Results Included were 227 patients after 2196 pancreatoduodenectomies. Primary catheter drainage was successful in 175 (77%) of 227 patients. Multivariable logistic regression revealed the following negative prognostic factors for success: male sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-1.00; P = 0.049), higher age (for every 5 years over 50; OR, 0.69; 95% CI, 0.57-0.84; P < 0.001), and respiratory failure at time of catheter drainage (OR, 0.10; 95% CI, 0.03-0.33; P < 0.001). A prognostic model incorporating these factors yielded an area under the curve of 0.76 and demonstrated a success range of 98% to 14%. Conclusions Male sex, higher age, and respiratory failure are associated with a low success rate of catheter drainage in patients with pancreatic fistula after pancreatoduodenectomy. These patients might benefit from an intensified postoperative monitoring for early detection and management of pancreatic fistula to prevent respiratory failure.
AB - The objective of this study was to identify predictors for successful minimally invasive catheter drainage (ie, survival without relaparotomy) for pancreatic fistula after pancreatoduodenectomy. Methods Included were consecutive patients undergoing catheter drainage as first intervention for pancreatic fistula after pancreatoduodenectomy (2005-2013) in 9 Dutch centers. Possible prognostic factors for successful catheter drainage (ie, survival without relaparotomy) were selected using Akaike information criterion. Results Included were 227 patients after 2196 pancreatoduodenectomies. Primary catheter drainage was successful in 175 (77%) of 227 patients. Multivariable logistic regression revealed the following negative prognostic factors for success: male sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-1.00; P = 0.049), higher age (for every 5 years over 50; OR, 0.69; 95% CI, 0.57-0.84; P < 0.001), and respiratory failure at time of catheter drainage (OR, 0.10; 95% CI, 0.03-0.33; P < 0.001). A prognostic model incorporating these factors yielded an area under the curve of 0.76 and demonstrated a success range of 98% to 14%. Conclusions Male sex, higher age, and respiratory failure are associated with a low success rate of catheter drainage in patients with pancreatic fistula after pancreatoduodenectomy. These patients might benefit from an intensified postoperative monitoring for early detection and management of pancreatic fistula to prevent respiratory failure.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85067618040&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31210662
U2 - https://doi.org/10.1097/MPA.0000000000001334
DO - https://doi.org/10.1097/MPA.0000000000001334
M3 - Article
C2 - 31210662
SN - 0885-3177
VL - 48
SP - 811
EP - 816
JO - Pancreas
JF - Pancreas
IS - 6
ER -