Total bilirubin level on postoperative day 3 in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy : a retrospective study

Abstract

Background: The prevalence of clinically relevant postoperative pancreatic fistulas (CR-POPF) following pancreaticoduodenectomy (PD) is relatively high. Most studies on the prediction of CR-POPF are limited to pre-operation, while there are few indicators to predict CR-POPF in the early postoperative period. The purpose of this study was to investigate the value of total bilirubin (TBIL) level on postoperative day 3 in predicting CR-POPF after PD. Methods: The clinical data of 170 patients who underwent PD in our team from January 2015 to October 2022 was retrospectively analyzed into two groups: the CR-POPF group with a grade B or C pancreatic fistula (n = 37), the no CR-POPF group with a non-pancreatic fistula, and the biochemical fistula patients (n = 133). Univariate and multivariate analyses were used to screen the potential indicators for predicting CR-POPF. The predictive value of risk factors was assessed by area under the ROC curve. Results: Preoperative variables, including hemoglobin (Hb), C-reactive protein (CRP), TBIL, albumin (ALB), pancreatic texture, hemorrhage, duct diameter, and TBIL on postoperative day 3, were identified as predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) (p < 0.001). The multivariate logistic regression analysis revealed that pancreatic texture (p = 0.004), postoperative TBIL (p<0.001), and preoperative CRP (p = 0.048) were identified as independent risk variables. To predict CR-POPF, the area under the curve (AUC) of pancreatic texture, TBIL on the third day of surgery, and preoperative CRP were found to be 0.607, 0.824, and 0.726, respectively. Conclusion: The TBIL level on postoperative day 3 is a significant predictor of CR-POPF after PD which can accurately predict CR-POPF.