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 POPE 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(2) 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).
Conclusion: 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 .
Original language | English |
---|---|
Pages (from-to) | 937-943 |
Number of pages | 7 |
Journal | Annals of Surgery |
Volume | 269 |
Issue number | 5 |
DOIs | |
Publication status | Published - May 2019 |
Keywords
- complication
- pancreas
- pancreatic fistula
- prediction model
- POSTOPERATIVE PANCREATIC FISTULA
- LOGISTIC-REGRESSION ANALYSIS
- BLOOD-LOSS
- PREDICTION
- PERFORMANCE
- MODELS
- SYSTEM
- MANAGEMENT
- DRAINAGE
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Mungroop, T. H., van Rijssen, L. B., van Klaveren, D., Smits, F. J., van Woerden, V., Linnemann, R. J., de Pastena, M., Klompmaker, S., Marchegiani, G., Ecker, B. L., van Dieren, S., Bonsing, B., Busch, O. R., van Dam, R. M., Erdmann, J., van Eijck, C. H., Gerhards, M. E., van Goor, H., van der Harst, E., ... Dutch Pancreatic Canc Grp (2019). Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) Design and International External Validation. Annals of Surgery, 269(5), 937-943. https://doi.org/10.1097/SLA.0000000000002620
Mungroop, Timothy H. ; van Rijssen, L. Bengt ; van Klaveren, David et al. / Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) Design and International External Validation. In: Annals of Surgery. 2019 ; Vol. 269, No. 5. pp. 937-943.
@article{0b2bf1f949d34e56a0f91f73434d44c9,
title = "Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) Design and International External Validation",
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 POPE 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(2) 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).Conclusion: 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 .",
keywords = "complication, pancreas, pancreatic fistula, prediction model, POSTOPERATIVE PANCREATIC FISTULA, LOGISTIC-REGRESSION ANALYSIS, BLOOD-LOSS, PREDICTION, PERFORMANCE, MODELS, SYSTEM, MANAGEMENT, DRAINAGE",
author = "Mungroop, {Timothy H.} and {van Rijssen}, {L. Bengt} and {van Klaveren}, David and Smits, {F. Jasmijn} and {van Woerden}, Victor and Linnemann, {Ralph J.} and {de Pastena}, Matteo and Sjors Klompmaker and Giovanni Marchegiani and Ecker, {Brett L.} and {van Dieren}, Susan and Bert Bonsing and Busch, {Olivier R.} and {van Dam}, {Ronald M.} and Joris Erdmann and {van Eijck}, {Casper H.} and Gerhards, {Michael E.} and {van Goor}, Harry and {van der Harst}, Erwin and {de Hingh}, {Ignace H.} and {de Jong}, {Koert P.} and Geert Kazemier and Misha Luyer and Awad Shamali and Salvatore Barbaro and Thomas Armstrong and Arjun Takhar and Zaed Hamady and Joost Klaase and Lips, {Daan J.} and Molenaar, {I. Quintus} and Nieuwenhuijs, {Vincent B.} and Coen Rupert and {van Santvoort}, {Hjalmar C.} and Scheepers, {Joris J.} and {van der Schelling}, {George P.} and Claudio Bassi and Vollmer, {Charles M.} and Steyerberg, {Ewout W.} and {Abu Hilal}, Mohammed and Koerkamp, {Bas Groot} and Besselink, {Marc G.} and {Dutch Pancreatic Canc Grp}",
note = "Funding Information: This research was funded in part by a grant from the Dutch Cancer Society (grant number UVA2013-5842). Publisher Copyright: {\textcopyright} 2018 The Author(s). Published by Wolters Kluwer Health, Inc.",
year = "2019",
month = may,
doi = "10.1097/SLA.0000000000002620",
language = "English",
volume = "269",
pages = "937--943",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "5",
}
Mungroop, TH, van Rijssen, LB, van Klaveren, D, Smits, FJ, van Woerden, V, Linnemann, RJ, de Pastena, M, Klompmaker, S, Marchegiani, G, Ecker, BL, van Dieren, S, Bonsing, B, Busch, OR, van Dam, RM, Erdmann, J, van Eijck, CH, Gerhards, ME, van Goor, H, van der Harst, E, de Hingh, IH, de Jong, KP, Kazemier, G, Luyer, M, Shamali, A, Barbaro, S, Armstrong, T, Takhar, A, Hamady, Z, Klaase, J, Lips, DJ, Molenaar, IQ, Nieuwenhuijs, VB, Rupert, C, van Santvoort, HC, Scheepers, JJ, van der Schelling, GP, Bassi, C, Vollmer, CM, Steyerberg, EW, Abu Hilal, M, Koerkamp, BG, Besselink, MG & Dutch Pancreatic Canc Grp 2019, 'Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) Design and International External Validation', Annals of Surgery, vol. 269, no. 5, pp. 937-943. https://doi.org/10.1097/SLA.0000000000002620
Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) Design and International External Validation. / Mungroop, Timothy H.; van Rijssen, L. Bengt; van Klaveren, David et al.
In: Annals of Surgery, Vol. 269, No. 5, 05.2019, p. 937-943.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) Design and International External Validation
AU - Mungroop, Timothy H.
AU - van Rijssen, L. Bengt
AU - van Klaveren, David
AU - Smits, F. Jasmijn
AU - van Woerden, Victor
AU - Linnemann, Ralph J.
AU - de Pastena, Matteo
AU - Klompmaker, Sjors
AU - Marchegiani, Giovanni
AU - Ecker, Brett L.
AU - van Dieren, Susan
AU - Bonsing, Bert
AU - Busch, Olivier R.
AU - van Dam, Ronald M.
AU - Erdmann, Joris
AU - van Eijck, Casper H.
AU - Gerhards, Michael E.
AU - van Goor, Harry
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - de Jong, Koert P.
AU - Kazemier, Geert
AU - Luyer, Misha
AU - Shamali, Awad
AU - Barbaro, Salvatore
AU - Armstrong, Thomas
AU - Takhar, Arjun
AU - Hamady, Zaed
AU - Klaase, Joost
AU - Lips, Daan J.
AU - Molenaar, I. Quintus
AU - Nieuwenhuijs, Vincent B.
AU - Rupert, Coen
AU - van Santvoort, Hjalmar C.
AU - Scheepers, Joris J.
AU - van der Schelling, George P.
AU - Bassi, Claudio
AU - Vollmer, Charles M.
AU - Steyerberg, Ewout W.
AU - Abu Hilal, Mohammed
AU - Koerkamp, Bas Groot
AU - Besselink, Marc G.
AU - Dutch Pancreatic Canc Grp
N1 - Funding Information:This research was funded in part by a grant from the Dutch Cancer Society (grant number UVA2013-5842).Publisher Copyright:© 2018 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2019/5
Y1 - 2019/5
N2 - 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 POPE 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(2) 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).Conclusion: 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 .
AB - 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 POPE 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(2) 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).Conclusion: 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 .
KW - complication
KW - pancreas
KW - pancreatic fistula
KW - prediction model
KW - POSTOPERATIVE PANCREATIC FISTULA
KW - LOGISTIC-REGRESSION ANALYSIS
KW - BLOOD-LOSS
KW - PREDICTION
KW - PERFORMANCE
KW - MODELS
KW - SYSTEM
KW - MANAGEMENT
KW - DRAINAGE
U2 - 10.1097/SLA.0000000000002620
DO - 10.1097/SLA.0000000000002620
M3 - Article
C2 - 29240007
SN - 0003-4932
VL - 269
SP - 937
EP - 943
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -
Mungroop TH, van Rijssen LB, van Klaveren D, Smits FJ, van Woerden V, Linnemann RJ et al. Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) Design and International External Validation. Annals of Surgery. 2019 May;269(5):937-943. doi: 10.1097/SLA.0000000000002620