Drain amylase values for clinically relevant post-operative pancreatic fistulae

IF 0.3 4区医学 Q4 SURGERY

Surgical Practice Pub Date : 2024-08-15 DOI:10.1111/1744-1633.12715

Pipit Burasakarn MD, PhD, Sermsak Hongjinda MD, Anuparp Thienhiran MD, Pusit Fuengfoo MD

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引用次数: 0

Abstract

Aim

This study aims to identify the cut-off drain amylase (DA) values on the first, third, and fifth post-operative days (POD1-DA, POD3-DA, and POD5-DA) that are correlated with clinically relevant post-operative pancreatic fistula (CR-POPF).

Patients and Methods

All data were retrospectively collected from patients who underwent pancreatectomy at the Department of Surgery, Phramongkutklao Hospital, from January 2015 to December 2023. A total of 195 patients were included in the study.

Results

A total of 195 patients were analysed, including 35 patients with CR-POPF, with a mean age of 60.84 years. There were no statistically significant differences in demographic data between patients with CR-POPF and those without. In addition, no statistical differences were observed in pancreatic duct diameter (3 mm vs 2 mm), operative time (468.9 min vs 500.29 min), or blood loss (600 mL vs 600 mL) between the CR-POPF and no CR-POPF groups. Length of hospital stays was longer in the CR-POPF group compared with the no CR-POPF group (33 days vs 11 days, P = .001). In addition, the CR-POPF group had significantly higher rates of post-operative pancreatic haemorrhage (20% vs 2.5%), bile leakage (5.71% vs 0%), delayed gastric emptying (45.71% vs 3.13%), wound complications (34.29% vs 5%), and mortality (17.14% vs 1.88%) compared with the no CR-POPF group. The optimal cut-off values for CR-POPF were 1313 U/L on day 1 (D1; area under the curve [AUC] 0.72, 95% confidence interval [CI] 0.65–0.84, sensitivity 91%, specificity 52%), 492 U/L on D3 (AUC 0.77, 95% CI 0.70–0.83, sensitivity 91%, specificity 64%), and 360 U/L on D5 (AUC 0.65, 95% CI 0.52–0.75, sensitivity 69%, specificity 61%). There were no significant perioperative factors associated with CR-POPF in our study.

Conclusion

DA levels of 1313, 492, and 360 U/L on post-operative D1, D3, and D5, respectively, were associated with CR-POPF. Drain removal can be safely performed without the risk of CR-POPF when these levels are met.

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胰瘘术后引流淀粉酶值的临床意义

目的本研究旨在确定术后第一天、第三天和第五天（POD1-DA、POD3-DA 和 POD5-DA）的排水淀粉酶（DA）临界值与临床相关的术后胰瘘（CR-POPF）的相关性。患者和方法所有数据均为回顾性收集，来自 2015 年 1 月至 2023 年 12 月期间在 Phramongkutklao 医院外科接受胰腺切除术的患者。研究共纳入 195 名患者。结果共分析了 195 名患者，其中包括 35 名 CR-POPF 患者，平均年龄为 60.84 岁。CR-POPF 患者与非 CR-POPF 患者的人口统计学数据差异无统计学意义。此外，在胰管直径（3 毫米对 2 毫米）、手术时间（468.9 分钟对 500.29 分钟）或失血量（600 毫升对 600 毫升）方面，CR-POPF 组和非 CR-POPF 组之间也没有统计学差异。与无 CR-POPF 组相比，CR-POPF 组的住院时间更长（33 天 vs 11 天，P = .001）。此外，与无 CR-POPF 组相比，CR-POPF 组的术后胰腺出血率（20% vs 2.5%）、胆汁渗漏率（5.71% vs 0%）、胃排空延迟率（45.71% vs 3.13%）、伤口并发症率（34.29% vs 5%）和死亡率（17.14% vs 1.88%）都明显更高。CR-POPF 的最佳临界值为：第 1 天 1313 U/L（D1；曲线下面积 [AUC] 0.72，95% 置信区间 [CI] 0.65-0.84，灵敏度 91%，特异度 52%），D3 492 U/L（AUC 0.77，95% CI 0.70-0.83，灵敏度 91%，特异度 64%），D5 360 U/L（AUC 0.65，95% CI 0.52-0.75，灵敏度 69%，特异度 61%）。在我们的研究中，没有与 CR-POPF 相关的重要围手术期因素。结论术后 D1、D3 和 D5 的 DA 水平分别为 1313、492 和 360 U/L 与 CR-POPF 相关。当达到这些水平时，可以安全地拔除引流管，而不会有 CR-POPF 的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Practice 医学-外科

CiteScore

0.90

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Surgical Practice is a peer-reviewed quarterly journal, which is dedicated to the art and science of advances in clinical practice and research in surgery. Surgical Practice publishes papers in all fields of surgery and surgery-related disciplines. It consists of sections of history, leading articles, reviews, original papers, discussion papers, education, case reports, short notes on surgical techniques and letters to the Editor.