Drain data to predict clinically relevant pancreatic fistula

HPB (Oxford). 2010 Sep;12(7):472-81. doi: 10.1111/j.1477-2574.2010.00212.x.


Background: Post-operative pancreatic fistula (POPF) is a common and potentially devastating complication of pancreas resection. Management of this complication is important to the pancreas surgeon.

Objective: The aim of the present study was to evaluate whether drain data accurately predicts clinically significant POPF.

Methods: A prospectively maintained database with daily drain amylase concentrations and output volumes from 177 consecutive pancreatic resections was analysed. Drain data, demographic and operative data were correlated with POPF (ISGPF Grade: A--clinically silent, B--clinically evident, C--severe) to determine predictive factors.

Results: Twenty-six (46.4%) out of 56 patients who underwent distal pancreatectomy and 52 (43.0%) out of 121 patients who underwent a Whipple procedure developed a POPF (Grade A-C). POPFs were classified as A (24, 42.9%) and C (2, 3.6%) after distal pancreatectomy whereas they were graded as A (35, 28.9%), B (15, 12.4%) and C (2, 1.7%) after Whipple procedures. Drain data analysis was limited to Whipple procedures because only two patients developed a clinically significant leak after distal pancreatectomy. The daily total drain output did not differ between patients with a clinical leak (Grades B/C) and patients without a clinical leak (no leak and Grade A) on post-operative day (POD) 1 to 7. Although the median amylase concentration was significantly higher in patients with a clinical leak on POD 1-6, there was no day that amylase concentration predicted a clinical leak better than simply classifying all patients as 'no leak' (maximum accuracy = 86.1% on POD 1, expected accuracy by chance = 85.6%, kappa = 10.2%).

Conclusion: Drain amylase data in the early post-operative period are not a sensitive or specific predictor of which patients will develop clinically significant POPF after pancreas resection.

MeSH terms

  • Aged
  • Amylases / metabolism
  • Biomarkers / metabolism
  • Drainage / adverse effects*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Pancreatectomy / adverse effects*
  • Pancreatic Fistula / diagnosis
  • Pancreatic Fistula / etiology*
  • Pancreaticoduodenectomy / adverse effects*
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Texas
  • Time Factors
  • Up-Regulation


  • Biomarkers
  • Amylases