Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation
EAES Academy. van Bodegraven W. 07/05/22; 363081; P126
Ward van Bodegraven
Contributions
Contributions
Abstract
Introduction:
Preoperative estimation of the risk of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) can be used for the selection of preventive strategies, for benchmarking across centers, and stratifying patients by baseline risk in clinical studies. The aim was to develop and externally validate the first clinical risk score for POPF after DP.
Method:
Predictive variables for POPF were found using data of patients undergoing DP in two Italian centers (2014-2016) utilizing multivariable logistic regression. A prediction model was designed based on the significant variables. These data were pooled with the data of three Dutch centers and in two US centers (2007-2016). Discrimination and calibration were assessed in an internal-external validation procedure.
Results:
Overall, 1336 patients were included, of whom 291 (22%) developed a POPF grade B/C. A preoperative risk score was developed, including two variables: pancreatic neck thickness (OR: 1.14 [95% 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 in the design cohort (AUC: 0.80 (95% CI: 0.76-0.84)) and after internal-external validation (AUC: 0.73 (95% CI: 0.70-0.76)). Three risk groups were identified: low-risk (0-10%), intermediate-risk (10-25%), and high-risk (>25%).
Conclusions:
The Distal Fistula Risk Score (D-FRS) is the first externally validated risk score that successfully predicts the risk of POPF after distal pancreatectomy. It can be easily calculated preoperatively using www.pancreascalculator.com. The three distinct risk groups may facilitate personalized treatment.
Preoperative estimation of the risk of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) can be used for the selection of preventive strategies, for benchmarking across centers, and stratifying patients by baseline risk in clinical studies. The aim was to develop and externally validate the first clinical risk score for POPF after DP.
Method:
Predictive variables for POPF were found using data of patients undergoing DP in two Italian centers (2014-2016) utilizing multivariable logistic regression. A prediction model was designed based on the significant variables. These data were pooled with the data of three Dutch centers and in two US centers (2007-2016). Discrimination and calibration were assessed in an internal-external validation procedure.
Results:
Overall, 1336 patients were included, of whom 291 (22%) developed a POPF grade B/C. A preoperative risk score was developed, including two variables: pancreatic neck thickness (OR: 1.14 [95% 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 in the design cohort (AUC: 0.80 (95% CI: 0.76-0.84)) and after internal-external validation (AUC: 0.73 (95% CI: 0.70-0.76)). Three risk groups were identified: low-risk (0-10%), intermediate-risk (10-25%), and high-risk (>25%).
Conclusions:
The Distal Fistula Risk Score (D-FRS) is the first externally validated risk score that successfully predicts the risk of POPF after distal pancreatectomy. It can be easily calculated preoperatively using www.pancreascalculator.com. The three distinct risk groups may facilitate personalized treatment.
Introduction:
Preoperative estimation of the risk of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) can be used for the selection of preventive strategies, for benchmarking across centers, and stratifying patients by baseline risk in clinical studies. The aim was to develop and externally validate the first clinical risk score for POPF after DP.
Method:
Predictive variables for POPF were found using data of patients undergoing DP in two Italian centers (2014-2016) utilizing multivariable logistic regression. A prediction model was designed based on the significant variables. These data were pooled with the data of three Dutch centers and in two US centers (2007-2016). Discrimination and calibration were assessed in an internal-external validation procedure.
Results:
Overall, 1336 patients were included, of whom 291 (22%) developed a POPF grade B/C. A preoperative risk score was developed, including two variables: pancreatic neck thickness (OR: 1.14 [95% 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 in the design cohort (AUC: 0.80 (95% CI: 0.76-0.84)) and after internal-external validation (AUC: 0.73 (95% CI: 0.70-0.76)). Three risk groups were identified: low-risk (0-10%), intermediate-risk (10-25%), and high-risk (>25%).
Conclusions:
The Distal Fistula Risk Score (D-FRS) is the first externally validated risk score that successfully predicts the risk of POPF after distal pancreatectomy. It can be easily calculated preoperatively using www.pancreascalculator.com. The three distinct risk groups may facilitate personalized treatment.
Preoperative estimation of the risk of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) can be used for the selection of preventive strategies, for benchmarking across centers, and stratifying patients by baseline risk in clinical studies. The aim was to develop and externally validate the first clinical risk score for POPF after DP.
Method:
Predictive variables for POPF were found using data of patients undergoing DP in two Italian centers (2014-2016) utilizing multivariable logistic regression. A prediction model was designed based on the significant variables. These data were pooled with the data of three Dutch centers and in two US centers (2007-2016). Discrimination and calibration were assessed in an internal-external validation procedure.
Results:
Overall, 1336 patients were included, of whom 291 (22%) developed a POPF grade B/C. A preoperative risk score was developed, including two variables: pancreatic neck thickness (OR: 1.14 [95% 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 in the design cohort (AUC: 0.80 (95% CI: 0.76-0.84)) and after internal-external validation (AUC: 0.73 (95% CI: 0.70-0.76)). Three risk groups were identified: low-risk (0-10%), intermediate-risk (10-25%), and high-risk (>25%).
Conclusions:
The Distal Fistula Risk Score (D-FRS) is the first externally validated risk score that successfully predicts the risk of POPF after distal pancreatectomy. It can be easily calculated preoperatively using www.pancreascalculator.com. The three distinct risk groups may facilitate personalized treatment.
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