Clinical and economic validation of grade B postoperative pancreatic fistula subclassification

Abstract

Purpose: Postoperative pancreatic fistula (POPF) is the most frequent complication after pancreaticoduodenectomy (PD). A subclassification of grade B POPF has been proposed and seems to better stratify POPF clinical burden and economic impact. Aim of this study was to validate from a clinical and economic standpoint grade B POPF subclassification in a consecutive series of patients who underwent PD. Method: All the patients who underwent PD and subsequently developed a postoperative biochemical leak (BL) or a POPF were included. POPF clinical burden was assessed by evaluating postoperative complications and length of hospital stay (LOS). POPF economic impact was assessed by evaluating the overall hospital costs. Results: Overall, 281 patients developed BL or POPF after PD. Of these, 59 patients had a BL (21%), 17 had a B1-POPF (6%), 97 had a B2-POPF (35%), 66 had a B3-POPF (23%), and 42 had a C-POPF (15%). The severity of overall complications significantly increased across BL and POPF categories (p<0.001), but it was comparable between BL and B1-POPF. There was no significant difference in terms of LOS between patients with BL and those with a B1-POPF (p=0.971). Similarly, LOS was comparable among patients with B3- and C-POPF (p=1.000). Overall hospital costs were similar for patients with BL and those with B1-POPF (p=1.000), whereas they significantly increased across the other POPF subgroups. Conclusion: A subclassification of grade B POPF can better stratify the increasing clinical burden and economic impact of POPF after PD. A grade B1 POPF has minimal clinical and economic consequences and could be incorporated in the definition of BL.