A Prospectively Validated Clinical Risk Score Accurately Predicts Pancreatic Fistula after Pancreatoduodenectomy
A Prospectively Validated Clinical Risk Score Accurately Predicts Pancreatic Fistula after Pancreatoduodenectomy
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DOI：
10.1016/j.jamcollsurg.2012.09.002
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发表时间：
2013-01-01
影响因子：
5.2
通讯作者：
Vollmer, Charles M., Jr.
中科院分区：
文献类型：
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作者：
Callery, Mark P.;Pratt, Wande B.;Vollmer, Charles M., Jr.
背景：临床相关的术后胰瘘（CR-POPF）是胰腺切除术的严重固有风险。术前CR-POPF风险评估目前是不充分的，很少取消需要切除的患者的资格。风险的最佳评估发生在术中，并应指导瘘管预防和应对措施。我们试图开发一种风险预测工具，CR-POPF的特点是术中评估，并揭示相关的临床和经济significants.Study设计：基于国际研究组的胰瘘分类，公认的风险因素CR-POPF（小管，软胰腺，高风险的病理，失血过多）进行了评估，在pancreaticostomy。从3种不同的结构中选择最佳风险评分范围模型，首先推导（n = 233），然后进行前瞻性验证（n = 212）。在4个评分范围内评价临床和经济结局（可忽略风险，0分;低风险，1 - 2分;中等风险，3 - 6分;高风险，7 - 10分）。失血过多的发病率最高。风管尺寸
BACKGROUND: Clinically relevant postoperative pancreatic fistulas (CR-POPF) are serious inherent risks of pancreatic resection. Preoperative CR-POPF risk assessment is currently inadequate and rarely disqualifies patients who need resection. The best evaluation of risk occurs intraoperatively, and should guide fistula prevention and response measures thereafter. We sought to develop a risk prediction tool for CR-POPF that features intraoperative assessment and reveals associated clinical and economic significance.STUDY DESIGN: Based on International Study Group of Pancreatic Fistula classification, recognized risk factors for CR-POPF (small duct, soft pancreas, high-risk pathology, excessive blood loss) were evaluated during pancreaticoduodenectomy. An optimal risk score range model, selected from 3 different constructs, was first derived (n = 233) and then validated prospectively (n = 212). Clinical and economic outcomes were evaluated across 4 ranges of scores (negligible risk, 0 points; low risk, 1 to 2; intermediate risk, 3 to 6; high risk, 7 to 10).RESULTS: Clinically relevant postoperative pancreatic fistulas occurred in 13% of patients. The incidence was greatest with excessive blood loss. Duct size