Validation of Fistula Risk Score calculator in diverse North American HPB practices

Jan Grendar, Zeljka Jutric, Julie N. Leal, Chad G. Ball, Kimberly Bertens, Elijah Dixon, Chet W. Hammill, Zachary Kastenberg, Pippa H. Newell, Flavio Rocha, Brendan Visser, Ronald F. Wolf, Paul D. Hansen

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Background Fistula Risk Score (FRS) is a previously developed tool to assess the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD). Methods Prospectively collected databases from 4 university affiliated and non-affiliated HPB centers in United States and Canada were used. The influence of individual baseline characteristics, FRS and FRS group on CR-POPF was assessed in univariate and multivariate analyses. FRS calculator performance was assessed using a C-statistic. Results 444 patients were identified. Pathology, soft pancreas texture and pancreatic duct size were associated with CR-POPF rates (p < 0.001 for each); EBL was not (p = 0.067). The negligible risk group consisted of 50 (11.3%) patients, low risk of 118 (26.6%), moderate 234 (52.7%) and high risk group of 42 (9.5%) patients. The overall rate of CR-POPF was 20%. Of the patients in the negligible risk group, 2% developed CR-POPF, 13.6% of the low risk, 23.1% moderate and 42.9% in the high risk group (p < 0.001). Overall C-statistic was 0.719. Conclusion FRS is robust and able to stratify the risk of developing CR-POPF following PD in diverse North American academic and non-academic institutions. The FRS should be used in research and to guide clinical management of patients post PD in these institutions.

Original languageEnglish
Pages (from-to)508-514
Number of pages7
Issue number6
StatePublished - Jun 2017


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