Risk Factors and Medico-Economic Effect of Pancreatic Fistula after Pancreaticoduodenectomy
Table 2
Analysis for potential-related risk of pancreaticocutaneous fistula (PF) factors (univariate and multivariate analysis).
(a)
Patient-related factors for PF
Variants
PF
NOPF
Univariate analysis
Multivariate analysis
No. (%)
No. (%)
ORadj (95% CI)
ORadj (95% CI)
Smoking
0.499
Yes
34 (27.0)
68 (23.8)
1
No
92 (73.0)
218 (76.2)
0.847 (0.524–1.370)
Heavy smoking (cigarettes/day)
0.17
≥20
24 (19.0)
39 (13.6)
1
<20
102 (81.0)
247 (86.4)
0.675 (0.385–1.184)
Excessive drinking
0.029
0.003
Yes
35 (27.8)
53 (18.5)
1
1
No
91 (72.2)
233 (81.5)
0.577 (0.352–0.947)
0.390 (0.210–0.724)
Cholangitis
0.06
Yes
21 (16.7)
29 (10.1)
1
No
105 (83.3)
257 (89.9)
0.577 (0.303–1.024)
Cholecystitis
0.054
Yes
105 (83.3)
213 (74.5)
1
No
21 (16.7)
73 (25.5)
0.588 (0.342–1.010)
Jaundice
0.671
Yes
87 (69.0)
202 (70.6)
1
No
39 (31.0)
84 (29.4)
1.104 (0.698–1.747)
Coronary heart disease
0.029
0.018
Yes
16 (12.7)
16 (5.6)
1
1
No
110 (87.3)
270 (94.4)
0.441 (0.211–0.919)
0.324 (0.127–0.828)
Hypertension
0.353
Yes
17 (13.6)
26 (9.1)
1
No
108 (86.4)
259 (90.9)
0.728 (0.373–1.422)
Diabetes mellitus
0.624
Yes
14 (11.2)
27 (9.5)
1
No
111 (88.8)
257 (90.5)
0.842 (0.424–1.674)
Preoperative serum total bilirubin (mol/L)
0.83
≤17.1
28 (22.2)
63 (22.0)
1
>17.1
98 (77.8)
223 (78.0)
0.946 (0.568–1.573)
Preoperative hemoglobin (g/L)
0.964
<90
3 (2.4)
7 (2.4)
1
≥90
123 (97.6)
279 (97.6)
1.032 (0.261–4.087)
Preoperative serum albumin (g/L)
0.006
<30
10 (7.9)
6 (2.1)
1
1
0.007
≥30
116 (92.1)
280 (97.9)
0.235 (0.083–0.666)
0.182 (0.053–0.626)
Postoperative serum albumin (g/L)
0.095
<30
51 (40.5)
93 (32.5)
1
≥30
75 (59.5)
193 (67.5)
0.689 (0.445–1.067)
Primary site of disease
0.674
Caput pancreatis
59 (46.8)
129 (45.1)
1
Duodenum
34 (27.0)
89 (31.1)
0.815 (0.492–1.349)
Biliary ducts
33 (26.2)
68 (23.8)
1.019 (0.605–1.717)
Pathologic diagnosis
0.371
Caput pancreatis cancer
48 (38.1)
91 (31.8)
1
Duodenal cancer
21 (16.7)
60 (21.0)
0.642 (0.348–1.184)
Cholangiocarcinoma
30 (23.8)
62 (21.7)
0.906 (0.516–1.590)
Pancreatitis
4 (3.2)
21 (7.3)
0.416 (0.134–1.294)
Carcinoma of ampulla
6 (4.8)
20 (7.0)
0.588 (0.220–1.570)
Others
17 (13.5)
32 (11.2)
1.141 (0.568–2.295)
Texture of the remnant pancreas
0.016
0.037
Hard
20 (15.9)
77 (26.9)
1
1
Soft
106 (84.1)
209 (73.1)
1.964 (1.136–3.394)
1.955 (1.042–3.669)
Diameter of pancreatic duct (mm)
0.496
<3
68 (54.0)
142 (49.7)
1
≥3
58 (46.0)
144 (50.3)
0.863 (0.566–1.318)
(b) Operative- and therapeutic-related factors for PF
Variants
PF
NOPF
Univariate analysis
Multivariate analysis
No. (%)
No. (%)
ORadj (95% CI)
ORadj (95% CI)
Preoperative biliary drainage treatment
Yes
13 (10.3)
25 (8.7)
1
0.535
No
113 (89.7)
261 (91.3)
0.798 (0.392–1.625)
Operative time (min)
—
<295
19 (15.1)
67 (22.9)
1
0.161
—
≥295
107 (84.9)
226 (77.1)
0.669 (0.380–1.177)
—
Intraoperative blood loss (mL)
0.003
—
—
<300
35 (27.8)
121 (42.3)
1
—
—
300–600
30 (23.8)
81 (28.3)
1.194 (0.675–2.113)
—
—
600–900
28 (22.2)
45 (15.7)
2.089 (1.139–3.830)
—
—
≥900
33 (26.2)
39 (13.6)
2.738 (1.498–5.005)
—
—
Intraoperative blood transfusion (mL)
0.000
0.000
<300
41 (32.5)
136 (47.6)
1
1
300–600
23 (18.3)
67 (23.4)
1.112 (0.616–2.008)
1.128 (0.556–2.290)
0.738
600–900
31 (24.6)
57 (19.9)
1.754 (1.000–3.078)
2.574 (1.318–5.025)
0.006
≥900
31 (24.6)
26 (9.1)
3.711 (1.969–6.995)
5.115 (2.364–11.069)
0.000
Pancreatic duct stent drainage
0.000
0.394
No stent
40 (31.7)
49 (17.1)
1
1
0.570
Internal drainage
77 (61.1)
174 (60.8)
0.518 (0.313–0.856)
0.819 (0.412–1.629)
0.178
External drainage
9 (7.1)
63 (22.0)
0.162 (0.071–0.370)
0.476 (0.161–1.403)
0.624
Excision method
0.016
0.624
Without PP
108 (85.7)
266 (93.0)
1
1
With PP
18 (14.3)
20 (7.0)
2.300 (1.165–4.543)
1.240 (0.524–2.932)
Methods of anastomosis
0.005
0.026
Binding anastomosis
3 (2.4)
22 (7.7)
1
1
End-side invagination anastomosis
6 (4.8)
38 (13.3)
1.110 (0.251–4.911)
2.428 (0.439–13.432)
End-end invagination anastomosis
106 (84.1)
194 (67.8)
3.922 (1.143–13.456)
5.510 (1.391–21.821)
Duct-mucosa anastomosis
11 (8.7)
32 (11.2)
2.396 (0.595–9.642)
7.918 (1.619–38.722)
Laparoscopic operation
0.002
0.034
Yes
10 (7.9)
3 (1.0)
1
1
No
116 (92.1)
283 (99.0)
0.128 (0.034–0.477)
0.188 (0.040–0.883)
Early jejunal nutrition
0.065
Yes
25 (19.8)
81 (28.3)
1
No
101 (80.2)
205 (71.7)
1.617 (0.970–2.694)
Use of somatostatin after PD
0.059
Yes
84 (66.7)
161 (56.3)
1
No
42 (33.3)
125 (43.7)
0.655 (0.422–1.017)
Professional group
0.000
0.000
Yes
38 (30.2)
190 (66.4)
1
1
No
88 (69.8)
96 (33.6)
4.718 (2.985–7.457)
3.925 (2.250–6.847)
—: the multivariate analysis of intraoperative blood loss was not performed in this study because of its corresponding relationship with intraoperative blood transfusion. Missing values: 3 diabetes mellitus patients and 2 hypertension patients were missing. OR: odds ratio; CI: confidence interval; ORadj: adjusted ORs presented with 95% CI.
