The impact of a postoperative pancreatic fistula on clinical and economic outcomes following pancreaticoduodenectomy (original) (raw)

"Introduction: A postoperative pancreatic fistula is the most serious complication after pancreaticoduodenectomy (PD). We studied its impact on the patients’ clinical and economic outcomes in a tertiary care teaching hospital in India. Methods: We performed a prospective analysis of 95 patients who underwent PD in our hospital for various periampullary and pancreatic lesions between January 2009 and December 2012. The effect of the pancreatic fistula on the postoperative clinical and economic outcomes including the length of hospital stay and treatment cost was analyzed. Results: Thirty-five (36.8%) patients developed a fistula according to the International Study Group on Pancreatic Fistula (ISGPF) definition. There were 12 grade A fistulas (12.6%), 17 grade B (17.9%) and 6 grade C (6.6%). The median length of hospital stay for the no fistula, grades A, B, and C fistula groups was 11, 11, 15, and 17.5 days, respectively. The hospital stay of the patients significantly increased with the increasing severity of the fistula (p ¼ 0.002). The median total cost of the treatment was Indian Rupees 297605, 327768, 501374, and 671617 in the no fistula, grades A, B, and C fistula groups, respectively. Conclusions: The standardized definitions of PF as put forth by the ISGPF allow for more equitable comparison among institutions. Increasing PF grades had a negative clinical and economic impact on patients and their healthcare resources."

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