• Annals of surgery · Aug 2023

    Fistula Risk Score for Auditing Pancreatoduodenectomy: The Auditing FRS.

    • Jelle C van Dongen, Jacob L van Dam, Marc G Besselink, Bert A Bonsing, Koop Bosscha, Olivier R Busch, Ronald M van Dam, Sebastiaan Festen, Erwin van der Harst, Ignace H de Hingh, Geert Kazemier, LiemMike S LMSLDepartment of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., Vincent E de Meijer, Jan S D Mieog, Izaak Q Molenaar, Gijs A Patijn, Hjalmar C van Santvoort, Jan H Wijsman, StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Fennie Wit, Roeland F De Wilde, van EijckCasper H JCHJDepartment of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands., Bas Groot Koerkamp, and Dutch Pancreatic Cancer Group.
    • Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
    • Ann. Surg. 2023 Aug 1; 278 (2): e272e277e272-e277.

    ObjectiveTo develop a fistula risk score for auditing, to be able to compare postoperative pancreatic fistula (POPF) after pancreatoduodenectomy among hospitals.BackgroundFor proper comparisons of outcomes in surgical audits, case-mix variation should be accounted for.MethodsThis study included consecutive patients after pancreatoduodenectomy from the mandatory nationwide Dutch Pancreatic Cancer Audit. Derivation of the score was performed with the data from 2014 to 2018 and validation with 2019 to 2020 data. The primary endpoint of the study was POPF (grade B or C). Multivariable logistic regression analysis was performed for case-mix adjustment of known risk factors.ResultsIn the derivation cohort, 3271 patients were included, of whom 479 (14.6%) developed POPF. Male sex [odds ratio (OR)=1.34; 95% confidence interval (CI): 1.09-1.66], higher body mass index (OR=1.07; 95% CI: 1.05-1.10), a final diagnosis other than pancreatic ductal adenocarcinoma/pancreatitis (OR=2.41; 95% CI: 1.90-3.06), and a smaller duct diameter (OR=1.43/mm decrease; 95% CI: 1.32-1.55) were independently associated with POPF. Diabetes mellitus (OR=0.73; 95% CI: 0.55-0.98) was independently associated with a decreased risk of POPF. Model discrimination was good with a C -statistic of 0.73 in the derivation cohort and 0.75 in the validation cohort (n=913). Hospitals differed in particular in the proportion of pancreatic ductal adenocarcinoma/pancreatitis patients, ranging from 36.0% to 58.1%. The observed POPF risk per center ranged from 2.9% to 25.4%. The expected POPF rate based on the 5 risk factors ranged from 11.6% to 18.0% among hospitals.ConclusionsThe auditing fistula risk score was successful in case-mix adjustment and enables fair comparisons of POPF rates among hospitals.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…