Sequential drain amylase to guide drain removal following pancreatectomy

Nicole Villafane-Ferriol, George Van Buren, Jose E. Mendez-Reyes, Amy L. McElhany, Nader N. Massarweh, Eric J. Silberfein, Cary Hsu, Hop S. Tran Cao, Carl Schmidt, Nicholas J. Zyromski, Mary E. Dillhoff, Alexandra Roch, Evelyn Oliva, Alexander C. Smith, Qianzi Zhang, William E. Fisher

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal. Methods: Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test. Results: Among 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B. Conclusions: In patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful.

Original languageEnglish (US)
Pages (from-to)514-520
Number of pages7
JournalHPB
Volume20
Issue number6
DOIs
StatePublished - Jun 2018

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Villafane-Ferriol, N., Van Buren, G., Mendez-Reyes, J. E., McElhany, A. L., Massarweh, N. N., Silberfein, E. J., Hsu, C., Tran Cao, H. S., Schmidt, C., Zyromski, N. J., Dillhoff, M. E., Roch, A., Oliva, E., Smith, A. C., Zhang, Q., & Fisher, W. E. (2018). Sequential drain amylase to guide drain removal following pancreatectomy. HPB, 20(6), 514-520. https://doi.org/10.1016/j.hpb.2017.11.008