Drainage volume on postoperative day one to predict clinically relevant postoperative pancreatic fistula following distal pancreatectomy

Background: The purpose of this study was to determine how the drain fluid volume on the first day after surgery (DFV 1) can be used to predict clinically relevant post-operative pancreatic fistula following distal pancreatectomy (PD). Method: A retrospective analysis of 175 patients who underwent distal pancreatectomy in hepatobiliary surgery at Chengdu 363 Hospital (China) from January 2015 to January 2021 has been performed. Depending on the presence of pancreatic fistula, all patients were divided into two groups: POPF and non-POPF. In accordance with clinical impact on a patient's hospital course, the ISGPFD has defined three levels of POPF (grades A, B, C). The clinical factors were analyzed using SPSS 17.0 and Medcalc software. In order to assess the effectiveness of DFV 1 in predicting POPF after surgery, ROC curves were used to calculate its cut-off point. Result: Of the 175 patients who underwent distal pancreatectomy, 33 suffered with biochemical leaks, 28 (93.3%) with grade B POPFs, and 2 (6.7%) with grade C POPFs. The results from univariate and multivariate logistic regression analysis showed that the drain fluid volume on the first postoperative day (OR=0.99, P = 0.02) and the preoperative ALT level (OR=0.98, P =0.03) were independent risk factors associated with CR-POPF. Receiver operating characteristic (ROC) curve analysis showed that a drainage volume of 156 mL in 24 hours was an optimal threshold for the association with complications. The area under the curve was 0.624 (95% CI: 0.548-0.696). An average sensitivity and specificity of 46.67% and 76.55% were achieved respectively. Conclusion: After distal pancreatectomy, the drainage volume on the first postoperative day can predict the presence of a clinically relevant pancreatic fistula.