• Nicole Villafane-Ferriol, George Van Buren, Jose E Mendez-Reyes, Amy L McElhany, Nader N Massarweh, Eric J Silberfein, Cary Hsu, Hop S Tran Cao, Carl Schmidt, Nicholas J Zyromski, Mary E Dillhoff, Alexandra Roch, Evelyn Oliva, Alexander C Smith, Qianzi Zhang, and William E Fisher.
• Baylor College of Medicine, Michael E. DeBakey Department of Surgery, One Baylor Plaza Suite 404D, Houston, TX 77030, USA.
• HPB (Oxford). 2018 Jun 1; 20 (6): 514-520.

BackgroundAlthough used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal.MethodsData from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test.ResultsAmong 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B.ConclusionsIn patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful.Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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