Risk Factors and Medico-Economic Effect of Pancreatic Fistula after Pancreaticoduodenectomy
Table 3
Analysis for potential risk factors of pancreaticocutaneous fistula (CR-PF) factors (univariate and multivariate analysis).
(a) Patient-related factors for CR-PF
Variants
CR-PF
NOCR-PF
Univariate analysis
Multivariate analysis
No. (%)
No. (%)
ORadj (95% CI)
ORadj (95% CI)
Smoking
0.84
Yes
19 (25.7)
83 (24.6)
1
No
55 (74.3)
255 (75.4)
0.942 (0.529–1.678)
Heavy smoking (cigarettes/day)
0.191
≥20
15 (20.3)
48 (14.2)
1
<20
59 (79.3)
290 (85.8)
0.651 (0.342–1.239)
Excessive drinking
0.493
Yes
18 (24.3)
70 (20.7)
1
No
56 (75.7)
268 (79.3)
0.813 (0.449–1.470)
Cholangitis
0.002
Yes
17 (23.0)
33 (9.8)
1
No
57 (77.0)
305 (90.2)
0.363 (0.189–0.695)
Cholecystitis
0.075
0.004
Yes
63 (85.1)
255 (75.4)
1
1
No
11 (14.9)
83 (24.6)
0.536 (0.270–1.066)
0.321 (0.150–0.690)
Jaundice
0.054
Yes
45 (60.8)
244 (72.2)
1
No
29 (39.2)
94 (27.8)
1.673 (0.991–2.825)
Coronary heart disease
0.284
Yes
8 (10.8)
24 (7.1)
1
No
66 (89.2)
314 (92.9)
0.631 (0.271–1.465)
Hypertension
0.572
Yes
9 (12.3)
34 (10.1)
1
No
64 (87.7)
303 (89.9)
0.798 (0.365–1.745)
Diabetes mellitus
0.163
Yes
4 (5.5)
37 (11.0)
1
No
69 (94.5)
299 (89.0)
2.135 (0.736–6.188)
Preoperative serum total bilirubin (μmol/L)
0.412
≤17.1
19 (25.7)
72 (21.3)
1
>17.1
55 (74.3)
266 (78.7)
0.784 (0.437–1.404)
Preoperative hemoglobin (g/L)
0.324
<90
3 (4.1)
7 (2.1)
1
≥90
71 (95.9)
331 (97.9)
0.501 (0.126–1.983)
Preoperative serum albumin (g/L)
0
0.000
<30
9 (12.2)
7 (2.1)
1
1
≥30
65 (87.8)
331 (97.9)
0.153 (0.055–0.425)
0.107 (0.031–0.363)
Postoperative serum albumin (g/L)
0.971
<30
26 (35.1)
118 (34.9)
1
≥30
48 (64.9)
220 (65.1)
0.990 (0.585–1.677)
Primary site of disease
0.935
Caput pancreatis
34 (45.9)
154 (45.6)
1
Duodenum
23 (31.1)
100 (29.6)
1.042 (0.580–1.872)
Biliary ducts
17 (23.0)
84 (24.9)
0.917 (0.483–1.738)
Pathologic diagnosis
0.322
Caput pancreatis cancer
28 (37.8)
111 (32.8)
1
Duodenal cancer
13 (17.6)
68 (20.1)
0.758 (0.368–1.563)
Cholangiocarcinoma
15 (20.3)
77 (22.8)
0.772 (0.387–1.542)
Pancreatitis
1 (1.4)
24 (7.1)
0.165 (0.021–1.274)
Carcinoma of ampulla
4 (5.4)
22 (6.5)
0.721 (0.230–2.261)
Others
13 (17.6)
36 (10.7)
1.432 (0.671–3.054)
Texture of the remnant pancreas
0.013
0.044
Hard
9 (12.2)
88 (26.0)
1
1
Soft
65 (87.8)
250 (74.0)
2.542 (1.215–5.319)
2.316 (1.205–5.234)
Diameter of pancreatic duct (mm)
0.400
<3
41 (55.4)
169 (50.0)
1
≥3
33 (44.6)
169 (50.0)
0.805 (0.485–1.334)
(b) Operative- and therapeutic-related factors for CR-PF
Variants
CR-PF
NOCR-PF
Univariate analysis
Multivariate analysis
No. (%)
No. (%)
ORadj (95% CI)
ORadj (95% CI)
Preoperative biliary drainage treatment
0.068
Yes
11 (14.9)
27 (8.0)
1
No
63 (85.1)
311 (92.0)
0.497 (0.235–1.054)
Operative time (min)
1.081
<295
11 (14.9)
68 (20.1)
1
≥295
63 (85.1)
270 (79.9)
0.693 (0.347–1.387)
Intraoperative blood loss (mL)
0.004
—
—
<300
20 (27.0)
136 (40.2)
1
—
—
300–600
14 (18.9)
97 (28.7)
0.981 (0.473–2.039)
—
—
600–900
20 (27.0)
53 (15.7)
2.566 (1.279–5.148)
—
—
≥900
20 (27.0)
52 (15.4)
2.615 (1.302–5.253)
—
—
Intraoperative blood transfusion (mL)
0.002
0.001
<300
19 (25.7)
158 (46.7)
1
1
300–600
18 (24.3)
72 (21.3)
2.079 (1.030–4.196)
2.311 (1.049–5.092)
0.038
600–900
18 (24.3)
70 (20.7)
2.138 (1.058–4.321)
2.657 (1.207–5.851)
0.015
≥900
19 (25.7)
38 (11.2)
4.158 (2.008–8.609)
5.337 (2.301–12.376)
0.000
Pancreatic duct stent drainage
0.007
0.542
No stent
24 (32.4)
65 (19.2)
1
1
Internal drainage
45 (60.8)
206 (60.9)
0.592 (0.335–1.045)
0.692 (0.359–1.334)
0.272
External drainage
5 (6.8)
67 (19.8)
0.202 (0.073–0.562)
0.814 (0.248–2.671)
0.375
Excision method
0.068
Without PP
63 (85.1)
311 (92.0)
1
With PP
11 (14.9)
27 (8.0)
2.011 (0.949–4.264)
Methods of anastomosis
0.069
Binding anastomosis
2 (2.7)
23 (6.8)
1
End-side invagination anastomosis
3 (4.1)
41 (12.1)
0.841 (0.131–5.409)
End-end invagination anastomosis
63 (85.1)
237 (70.1)
3.057 (0.702–13.314)
Duct-mucosa anastomosis
6 (8.1)
37 (10.9)
1.865 (0.347–10.034)
Laparoscopic operation
0.231
Yes
4 (5.4)
9 (2.7)
1
No
70 (94.6)
329 (97.3)
0.479 (0.143–1.599)
Early jejunal nutrition
0.238
Yes
15 (20.3)
91 (26.9)
1
No
59 (79.7)
247 (73.1)
1.449 (0.783–2.682)
Use of somatostatin after PD
0.069
Yes
51 (68.9)
194 (57.4)
1
No
23 (31.1)
144 (42.6)
0.608 (0.355–1.040)
Professional group
0.000
0.000
Yes
16 (21.6)
212 (62.7)
1
1
No
58 (78.4)
126 (37.3)
6.099 (3.362–11.066)
5.674 (2.867–11.230)
—: 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.
