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- Title
Development and Validation of a Model for Postpancreatectomy Hemorrhage Risk.
- Authors
Birgin, Emrullah; Hempel, Sebastian; Reeg, Alina; Oehme, Florian; Schnizer, Annika; Rink, Johann S.; Froelich, Matthias F.; Hetjens, Svetlana; Plodeck, Verena; Nebelung, Heiner; Abdelhadi, Schaima; Rahbari, Mohammad; Téoule, Patrick; Rasbach, Erik; Reissfelder, Christoph; Weitz, Jürgen; Schoenberg, Stefan O.; Distler, Marius; Rahbari, Nuh N.
- Abstract
Key Points: Question: Can perioperative data be used to derive a risk model to predict late postpancreatectomy hemorrhage (PPH) secondary to clinically relevant postoperative pancreatic fistula (cr-POPF) after pancreatoduodenectomy? Findings: In this prognostic study of 293 patients with cr-POPF after pancreatoduodenectomy, 4 risk factors were identified and incorporated in a risk score model—the hemorrhage risk score—to predict late PPH. The prediction model was well calibrated and capable to predict late PPH with high discrimination values in both the derivation and external validation cohorts. Meaning: These findings suggest that the hemorrhage risk score can be used as a tool to predict late PPH using perioperative risk factors. Importance: Postpancreatectomy hemorrhage (PPH) due to postoperative pancreatic fistula (POPF) is a life-threatening complication after pancreatoduodenectomy. However, there is no prediction tool for early identification of patients at high risk of late PPH. Objective: To develop and validate a prediction model for PPH. Design, Setting, and Participants: This retrospective prognostic study included consecutive patients with clinically relevant POPF who underwent pancreatoduodenectomy from January 1, 2009, to May 20, 2023, at the University Hospital Mannheim (derivation cohort), and from January 1, 2012, to May 31, 2022, at the University Hospital Dresden (validation cohort). Data analysis was performed from May 30 to July 29, 2023. Exposure: Clinical and radiologic features of PPH. Main Outcomes and Measures: Accuracy of a predictive risk score of PPH. A multivariate prediction model—the hemorrhage risk score (HRS)—was established in the derivation cohort (n = 139) and validated in the validation cohort (n = 154). Results: A total of 293 patients (187 [64%] men; median age, 69 [IQR, 60-76] years) were included. The HRS comprised 4 variables with associations: sentinel bleeding (odds ratio [OR], 35.10; 95% CI, 5.58-221.00; P <.001), drain fluid culture positive for Candida species (OR, 14.40; 95% CI, 2.24-92.20; P <.001), and radiologic proof of rim enhancement of (OR, 12.00; 95% CI, 2.08-69.50; P =.006) or gas within (OR, 12.10; 95% CI, 2.22-65.50; P =.004) a peripancreatic fluid collection. Two risk categories were identified with patients at low risk (0-1 points) and high risk (≥2 points) to develop PPH. Patients with PPH were predicted accurately in the derivation cohort (C index, 0.97) and validation cohort (C index 0.83). The need for more invasive PPH management (74% vs 34%; P <.001) and severe complications (49% vs 23%; P <.001) were more frequent in high-risk patients compared with low-risk patients. Conclusions and Relevance: In this retrospective prognostic study, a robust prediction model for PPH was developed and validated. This tool may facilitate early identification of patients at high risk for PPH. This prognostic study develops a hemorrhage risk score model to predict the development of postpancreatectomy hemorrhage in patients who undergo pancreatoduodenectomy.
- Subjects
EXPERIMENTAL design; STATISTICS; CONFIDENCE intervals; RESEARCH methodology evaluation; RESEARCH methodology; MULTIVARIATE analysis; SURGICAL complications; RETROSPECTIVE studies; GOODNESS-of-fit tests; FISHER exact test; MANN Whitney U Test; COMPARATIVE studies; PEARSON correlation (Statistics); DESCRIPTIVE statistics; STATISTICAL hypothesis testing; ODDS ratio; DATA analysis software; LOGISTIC regression analysis; RECEIVER operating characteristic curves; PANCREATICODUODENECTOMY; HEMORRHAGE
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2346113
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.46113