Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation

Matteo De Pastena; Eduard A van Bodegraven; Timothy H Mungroop; Frederique L Vissers; Leia R Jones; Giovanni Marchegiani; Alberto Balduzzi; Sjors Klompmaker; Salvatore Paiella; Shazad Tavakoli Rad; Bas Groot Koerkamp; Casper van Eijck; Olivier R Busch; Ignace de Hingh; Misha Luyer; Caleb Barnhill; Thomas Seykora; Trudeau Maxwell T; Thijs de Rooij; Massimiliano Tuveri; Giuseppe Malleo; Alessandro Esposito; Luca Landoni; Luca Casetti; Adnan Alseidi; Roberto Salvia; Ewout W Steyerberg; Mohammad Abu Hilal; Charles M Vollmer; Marc G Besselink; Claudio Bassi

doi:10.1097/SLA.0000000000005497

Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation

Matteo De Pastena, Eduard A van Bodegraven, Timothy H Mungroop, Frederique L Vissers, Leia R Jones, Giovanni Marchegiani, Alberto Balduzzi, Sjors Klompmaker, Salvatore Paiella, Shazad Tavakoli Rad, Bas Groot Koerkamp, Casper van Eijck, Olivier R Busch, Ignace de Hingh, Misha Luyer, Caleb Barnhill, Thomas Seykora, Trudeau Maxwell T, Thijs de Rooij, Massimiliano TuveriGiuseppe Malleo, Alessandro Esposito, Luca Landoni, Luca Casetti, Adnan Alseidi, Roberto Salvia, Ewout W Steyerberg, Mohammad Abu Hilal, Charles M Vollmer, Marc G Besselink, Claudio Bassi

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: To develop 2 distinct preoperative and intraoperative risk scores to predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) to improve preventive and mitigation strategies, respectively.

BACKGROUND: POPF remains the most common complication after DP. Despite several known risk factors, an adequate risk model has not been developed yet.

METHODS: Two prediction risk scores were designed using data of patients undergoing DP in 2 Italian centers (2014-2016) utilizing multivariable logistic regression. The preoperative score (calculated before surgery) aims to facilitate preventive strategies and the intraoperative score (calculated at the end of surgery) aims to facilitate mitigation strategies. Internal validation was achieved using bootstrapping. These data were pooled with data from 5 centers from the United States and the Netherlands (2007-2016) to assess discrimination and calibration in an internal-external validation procedure.

RESULTS: Overall, 1336 patients after DP were included, of whom 291 (22%) developed POPF. The preoperative distal fistula risk score (preoperative D-FRS) included 2 variables: pancreatic neck thickness [odds ratio: 1.14; 95% confidence interval (CI): 1.11-1.17 per mm increase] and pancreatic duct diameter (OR: 1.46; 95% CI: 1.32-1.65 per mm increase). The model performed well with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.78-0.88) and 0.73 (95% CI: 0.70-0.76) upon internal-external validation. Three risk groups were identified: low risk (<10%), intermediate risk (10%-25%), and high risk (>25%) for POPF with 238 (18%), 684 (51%), and 414 (31%) patients, respectively. The intraoperative risk score (intraoperative D-FRS) added body mass index, pancreatic texture, and operative time as variables with an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.74-0.85).

CONCLUSIONS: The preoperative and the intraoperative D-FRS are the first validated risk scores for POPF after DP and are readily available at: http://www.pancreascalculator.com. The 3 distinct risk groups allow for personalized treatment and benchmarking.

Original language	English
Pages (from-to)	E1099-E1105
Journal	Annals of surgery
Volume	277
Issue number	5
Early online date	7 Jul 2022
DOIs	https://doi.org/10.1097/SLA.0000000000005497
Publication status	Published - 1 May 2023
Externally published	Yes

Keywords

distal pancreatectomy
pancreas
pancreatic cancer
pancreatic fistula
postoperative complications
prediction model

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10.1097/SLA.0000000000005497

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De Pastena, M., van Bodegraven, E. A., Mungroop, T. H., Vissers, F. L., Jones, L. R., Marchegiani, G., Balduzzi, A., Klompmaker, S., Paiella, S., Tavakoli Rad, S., Groot Koerkamp, B., van Eijck, C., Busch, O. R., de Hingh, I., Luyer, M., Barnhill, C., Seykora, T., Maxwell T, T., de Rooij, T., ... Bassi, C. (2023). Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation. Annals of surgery, 277(5), E1099-E1105. https://doi.org/10.1097/SLA.0000000000005497

@article{b330a322718048ff9b70f53b9e7ae79c,

title = "Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation",

abstract = "OBJECTIVE: To develop 2 distinct preoperative and intraoperative risk scores to predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) to improve preventive and mitigation strategies, respectively.BACKGROUND: POPF remains the most common complication after DP. Despite several known risk factors, an adequate risk model has not been developed yet.METHODS: Two prediction risk scores were designed using data of patients undergoing DP in 2 Italian centers (2014-2016) utilizing multivariable logistic regression. The preoperative score (calculated before surgery) aims to facilitate preventive strategies and the intraoperative score (calculated at the end of surgery) aims to facilitate mitigation strategies. Internal validation was achieved using bootstrapping. These data were pooled with data from 5 centers from the United States and the Netherlands (2007-2016) to assess discrimination and calibration in an internal-external validation procedure.RESULTS: Overall, 1336 patients after DP were included, of whom 291 (22%) developed POPF. The preoperative distal fistula risk score (preoperative D-FRS) included 2 variables: pancreatic neck thickness [odds ratio: 1.14; 95% confidence interval (CI): 1.11-1.17 per mm increase] and pancreatic duct diameter (OR: 1.46; 95% CI: 1.32-1.65 per mm increase). The model performed well with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.78-0.88) and 0.73 (95% CI: 0.70-0.76) upon internal-external validation. Three risk groups were identified: low risk (<10%), intermediate risk (10%-25%), and high risk (>25%) for POPF with 238 (18%), 684 (51%), and 414 (31%) patients, respectively. The intraoperative risk score (intraoperative D-FRS) added body mass index, pancreatic texture, and operative time as variables with an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.74-0.85).CONCLUSIONS: The preoperative and the intraoperative D-FRS are the first validated risk scores for POPF after DP and are readily available at: http://www.pancreascalculator.com. The 3 distinct risk groups allow for personalized treatment and benchmarking.",

keywords = "distal pancreatectomy, pancreas, pancreatic cancer, pancreatic fistula, postoperative complications, prediction model",

author = "{De Pastena}, Matteo and {van Bodegraven}, {Eduard A} and Mungroop, {Timothy H} and Vissers, {Frederique L} and Jones, {Leia R} and Giovanni Marchegiani and Alberto Balduzzi and Sjors Klompmaker and Salvatore Paiella and {Tavakoli Rad}, Shazad and {Groot Koerkamp}, Bas and {van Eijck}, Casper and Busch, {Olivier R} and {de Hingh}, Ignace and Misha Luyer and Caleb Barnhill and Thomas Seykora and {Maxwell T}, Trudeau and {de Rooij}, Thijs and Massimiliano Tuveri and Giuseppe Malleo and Alessandro Esposito and Luca Landoni and Luca Casetti and Adnan Alseidi and Roberto Salvia and Steyerberg, {Ewout W} and {Abu Hilal}, Mohammad and Vollmer, {Charles M} and Besselink, {Marc G} and Claudio Bassi",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2023",

month = may,

day = "1",

doi = "10.1097/SLA.0000000000005497",

language = "English",

volume = "277",

pages = "E1099--E1105",

journal = "Annals of surgery",

issn = "0003-4932",

publisher = "Lippincott Williams & Wilkins",

number = "5",

}

De Pastena, M, van Bodegraven, EA, Mungroop, TH, Vissers, FL, Jones, LR, Marchegiani, G, Balduzzi, A, Klompmaker, S, Paiella, S, Tavakoli Rad, S, Groot Koerkamp, B, van Eijck, C, Busch, OR, de Hingh, I, Luyer, M, Barnhill, C, Seykora, T, Maxwell T, T, de Rooij, T, Tuveri, M, Malleo, G, Esposito, A, Landoni, L, Casetti, L, Alseidi, A, Salvia, R, Steyerberg, EW, Abu Hilal, M, Vollmer, CM, Besselink, MG & Bassi, C 2023, 'Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation', Annals of surgery, vol. 277, no. 5, pp. E1099-E1105. https://doi.org/10.1097/SLA.0000000000005497

TY - JOUR

T1 - Distal Pancreatectomy Fistula Risk Score (D-FRS)

T2 - Development and International Validation

AU - De Pastena, Matteo

AU - van Bodegraven, Eduard A

AU - Mungroop, Timothy H

AU - Vissers, Frederique L

AU - Jones, Leia R

AU - Marchegiani, Giovanni

AU - Balduzzi, Alberto

AU - Klompmaker, Sjors

AU - Paiella, Salvatore

AU - Tavakoli Rad, Shazad

AU - Groot Koerkamp, Bas

AU - van Eijck, Casper

AU - Busch, Olivier R

AU - de Hingh, Ignace

AU - Luyer, Misha

AU - Barnhill, Caleb

AU - Seykora, Thomas

AU - Maxwell T, Trudeau

AU - de Rooij, Thijs

AU - Tuveri, Massimiliano

AU - Malleo, Giuseppe

AU - Esposito, Alessandro

AU - Landoni, Luca

AU - Casetti, Luca

AU - Alseidi, Adnan

AU - Salvia, Roberto

AU - Steyerberg, Ewout W

AU - Abu Hilal, Mohammad

AU - Vollmer, Charles M

AU - Besselink, Marc G

AU - Bassi, Claudio

PY - 2023/5/1

Y1 - 2023/5/1

N2 - OBJECTIVE: To develop 2 distinct preoperative and intraoperative risk scores to predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) to improve preventive and mitigation strategies, respectively.BACKGROUND: POPF remains the most common complication after DP. Despite several known risk factors, an adequate risk model has not been developed yet.METHODS: Two prediction risk scores were designed using data of patients undergoing DP in 2 Italian centers (2014-2016) utilizing multivariable logistic regression. The preoperative score (calculated before surgery) aims to facilitate preventive strategies and the intraoperative score (calculated at the end of surgery) aims to facilitate mitigation strategies. Internal validation was achieved using bootstrapping. These data were pooled with data from 5 centers from the United States and the Netherlands (2007-2016) to assess discrimination and calibration in an internal-external validation procedure.RESULTS: Overall, 1336 patients after DP were included, of whom 291 (22%) developed POPF. The preoperative distal fistula risk score (preoperative D-FRS) included 2 variables: pancreatic neck thickness [odds ratio: 1.14; 95% confidence interval (CI): 1.11-1.17 per mm increase] and pancreatic duct diameter (OR: 1.46; 95% CI: 1.32-1.65 per mm increase). The model performed well with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.78-0.88) and 0.73 (95% CI: 0.70-0.76) upon internal-external validation. Three risk groups were identified: low risk (<10%), intermediate risk (10%-25%), and high risk (>25%) for POPF with 238 (18%), 684 (51%), and 414 (31%) patients, respectively. The intraoperative risk score (intraoperative D-FRS) added body mass index, pancreatic texture, and operative time as variables with an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.74-0.85).CONCLUSIONS: The preoperative and the intraoperative D-FRS are the first validated risk scores for POPF after DP and are readily available at: http://www.pancreascalculator.com. The 3 distinct risk groups allow for personalized treatment and benchmarking.

AB - OBJECTIVE: To develop 2 distinct preoperative and intraoperative risk scores to predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) to improve preventive and mitigation strategies, respectively.BACKGROUND: POPF remains the most common complication after DP. Despite several known risk factors, an adequate risk model has not been developed yet.METHODS: Two prediction risk scores were designed using data of patients undergoing DP in 2 Italian centers (2014-2016) utilizing multivariable logistic regression. The preoperative score (calculated before surgery) aims to facilitate preventive strategies and the intraoperative score (calculated at the end of surgery) aims to facilitate mitigation strategies. Internal validation was achieved using bootstrapping. These data were pooled with data from 5 centers from the United States and the Netherlands (2007-2016) to assess discrimination and calibration in an internal-external validation procedure.RESULTS: Overall, 1336 patients after DP were included, of whom 291 (22%) developed POPF. The preoperative distal fistula risk score (preoperative D-FRS) included 2 variables: pancreatic neck thickness [odds ratio: 1.14; 95% confidence interval (CI): 1.11-1.17 per mm increase] and pancreatic duct diameter (OR: 1.46; 95% CI: 1.32-1.65 per mm increase). The model performed well with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.78-0.88) and 0.73 (95% CI: 0.70-0.76) upon internal-external validation. Three risk groups were identified: low risk (<10%), intermediate risk (10%-25%), and high risk (>25%) for POPF with 238 (18%), 684 (51%), and 414 (31%) patients, respectively. The intraoperative risk score (intraoperative D-FRS) added body mass index, pancreatic texture, and operative time as variables with an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.74-0.85).CONCLUSIONS: The preoperative and the intraoperative D-FRS are the first validated risk scores for POPF after DP and are readily available at: http://www.pancreascalculator.com. The 3 distinct risk groups allow for personalized treatment and benchmarking.

KW - distal pancreatectomy

KW - pancreas

KW - pancreatic cancer

KW - pancreatic fistula

KW - postoperative complications

KW - prediction model

UR - http://www.scopus.com/inward/record.url?scp=85141092042&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000005497

DO - 10.1097/SLA.0000000000005497

M3 - Article

C2 - 35797608

SN - 0003-4932

VL - 277

SP - E1099-E1105

JO - Annals of surgery

JF - Annals of surgery

IS - 5

ER -

Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation

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