Risk Factors And Prediction Model For Pancreatic Fistula After Distal Pancreatectomy

Objective: To investigate the risk factors of pancreatic fistula after distal pancreatectomy and to establish a nomogram for predicting the postoperative pancreatic fistula.Methods: The inclusion criteria and exclusion criteria were set at the beginning.A total of 738 patients who underwent distal pancreatectomy in the hospital of xx during January 1,2013 and June 30,2019 were retrospectively analyzed.Clinical and pathological data of these patients during the perioperative period were collected,including the preoperative general condition,previous medical history,blood test,imaging test;intraoperative operation method,operation time,blood loss;and postoperative blood test,imaging test,diagnosis and treatment,etc.SPSS23.0 was used for the data analysis of the risk factors of postoperative pancreatic fistula.And R(version 3.6.1)was used to construct and verify the nomogram for predicting the postoperative pancreatic fistula.P value less than 0.05 was considered statistically significant.Results: A total of 738 patients who received distal pancreatectomy were finally included in this study.The incidence of postoperative clinically related pancreatic fistula was 33.2%(245/738)and the mortality rate was 0.8%(6/738).Univariate analysis and multivariate logistic regression analysis revealed three independent risk factors afterdistal pancreatectomy among 31 perioperative variables: preoperative BMI(P=0.018),serum cholinesterase level(P=0.023),and serum triglyceride level(P<0.001).According to these three risk factors,a nomogram model was constructed to predict the pancreatic fistula after distal pancreatectomy.The C-index value was 0.724(95% CI:0.680-0.768),and the ROC curve and calibration plot showed that the nomogram model had a moderate prediction ability.Conclusion: preoperative BMI,serum cholinesterase level and serum triglyceride level were related to pancreatic fistula after distal pancreatectomy.In this study,we also constructed a nomogram to predict the postoperative pancreatic fistula after distal pancreatectomy,which can identify high-risk patients before surgery and help doctors develop personalized treatment plans.