Pubblicazioni

Decoding Grade B Pancreatic Fistula: A Clinical and Economical Analysis and Subclassification Proposal  (2019)

Autori:
Maggino, Laura; Malleo, Giuseppe; Bassi, Claudio; Allegrini, Valentina; Mcmillan, Matthew T; Borin, Alex; Chen, Bofeng; Drebin, Jeffrey A; Ecker, Brett L; Fraker, Douglas L; Lee, Major K; Paiella, Salvatore; Roses, Robert E; Salvia, Roberto; Vollmer, Charles M.
Titolo:
Decoding Grade B Pancreatic Fistula: A Clinical and Economical Analysis and Subclassification Proposal
Anno:
2019
Tipologia prodotto:
Articolo in Rivista
Tipologia ANVUR:
Articolo su rivista
Lingua:
Inglese
Referee:
No
Nome rivista:
Annals of Surgery
ISSN Rivista:
0003-4932
N° Volume:
269
Numero o Fascicolo:
6
Intervallo pagine:
1146-1153
Parole chiave:
NA
Breve descrizione dei contenuti:
OBJECTIVE: The aim of this study was to describe characteristics and management approaches for grade B pancreatic fistula (B-POPF) and investigate whether it segregates into distinct subclasses. BACKGROUND: The 2016 ISGPS refined definition of B-POPF is predicated on various postoperative management approaches, ranging from prolonged drainage to interventional procedures, but the spectrum of clinical severity within this entity is yet undefined. METHODS: Pancreatectomies performed at 2 institutions from 2007 to 2016 were reviewed to identify B-POPFs and their treatment strategies. Subclassification of B-POPFs into 3 classes was modeled after the Fistula Accordion Severity Grading System (B1: prolonged drainage only; B2: pharmacologic management; B3: interventional procedures). Clinical and economic outcomes, unique from the ISGPS definition qualifiers, were analyzed across subclasses. RESULTS: B-POPF developed in 320 of 1949 patients (16.4%), and commonly required antibiotics (70.3%), prolonged drainage (67.8%), and enteral/parenteral nutrition (54.7%). Percutaneous drainage occurred in 79 patients (24.7%), always in combination with other strategies. Management of B-POPFs was widely heterogeneous with a median of 2 approaches/patient (range 1 to 6) and 38 various strategy combinations used. Subclasses B1-3 comprised 19.1%, 52.2%, and 28.8% of B-POPFs, respectively, and were associated with progressively worse clinical and economic outcomes. These results were confirmed by multivariable analysis adjusted for clinical and operative factors. Notably, distribution of the B-POPF subclasses was influenced by institution and type of resection (P < 0.001), while clinical/demographic predictors proved elusive. CONCLUSION: B-POPF is a heterogeneous entity, where 3 distinct subclasses with increasing clinical and economic burden can be identified. This classification framework has potential implications for accurate reporting, comparative research, and performance evaluation.
Id prodotto:
100098
Handle IRIS:
11562/972217
ultima modifica:
15 novembre 2022
Citazione bibliografica:
Maggino, Laura; Malleo, Giuseppe; Bassi, Claudio; Allegrini, Valentina; Mcmillan, Matthew T; Borin, Alex; Chen, Bofeng; Drebin, Jeffrey A; Ecker, Brett L; Fraker, Douglas L; Lee, Major K; Paiella, Salvatore; Roses, Robert E; Salvia, Roberto; Vollmer, Charles M., Decoding Grade B Pancreatic Fistula: A Clinical and Economical Analysis and Subclassification Proposal «Annals of Surgery» , vol. 269 , n. 62019pp. 1146-1153

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