The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition.

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Background/Objectives: Complications after pancreatoduodenectomy (PD) lead to unplanned readmissions (UR), with a two- to threefold increase in admission costs. In this study, we aimed to create an understanding of the costs of complications and UR in this patient group. Furthermore, we aimed to generate a detailed cost overview that can be used to build a theoretical model to calculate the cost efficacy for prehabilitation. Methods: A retrospective cohort analysis was performed using the Dutch Pancreatic Cancer Audit (DPCA) database of patients who underwent a PD at our institute between 2013 and 2017. The total costs of the index hospital admission and UR related to the PD were collected. Results: Of the 160 patients; 35 patients (22%) had an uncomplicated course; 87 patients (54%) had minor complications, and 38 patients (24%) had severe complications. Median costs for an uncomplicated course were EUR 25.682, and for a complicated course, EUR 32.958 (p = 0.001). The median costs for minor complications were EUR 30.316, and for major complications, EUR 42.664 (p = 0.001). Costs were related to the Comprehensive Complication Index (CCI). The median costs of patients with one or more UR were EUR 41.199. Conclusions: Complications after PD led to a EUR 4.634–EUR 16.982 (18–66%) increase in hospital costs. A UR led to a cost increase of EUR 12.567 (44%). Since hospital costs are directly related to the CCI, reduction in complications will lead to cost-effectiveness.

pancreaticoduodenectomy (PD). Nowadays there exist modern intraabdominal vacuum techniques as an option of therapy besides the pancreatectomy of the rest. Methods: In our hospital we have treated two patients with type C POPF with intraabdominal vacuum bandages. For this we intraabdominally placed a silicone-coated (Mepi-thel®) polyurethane sponge (V.A.C.® GranuFoam™) under a continuous suction of between 75 and 125 mmHg at the target place. One of the applications was carried out via open surgery while the other one was done laparoscopically. In both cases the vacuum bandages have been repeatedly changed and finally an open wound management via wound tamponade was applied until the wounds healed definitely. Results: From January 2013 to December 2016 161 pancreatic surgeries have been carried out in our hospital. 100 cases thereof were PD with a total fistula rate of 16% (16/100). Among these there have been two cases of type A POPF (2%), 11 cases of type B POPF (11%) and three cases of type C POPF (3%). Two cases of type C POPF could be treated successfully by the use of intraabdominal vacuum bandages. No rest pancreatectomies have been necessary. Conclusion: The experiences in our hospital have shown that the above intraabdominal vacuum technique represents a sensible therapy option in the treatment of type C POPF and that by the use of a rest pancreatectomy can be avoided.

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