Risk factors predicting the development of a pancreatic fistula following pancreaticoduodenectomy: A retrospective cohort study

A postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy is considered a life-threatening complication. This study was designed to analyze the risk factors for the development of a POPF in a tertiary care center (Al-Rajhi Liver Hospital/Assiut University). We retrospectively analyzed 96 patients who underwent pancreaticoduodenectomy at our hospital from January 2017 to December 2020. A pancreatic fistula was defined according to the 2016 update of the International Study Group of Pancreatic Fistula. The risk factors for a pancreatic fistula were analyzed via a univariate analysis and multivariate logistic regression analysis. A clinically relevant pancreatic fistula was detected in 26/96 patients (27.1%) who underwent pancreaticoduodenectomy. The perioperative mortality rate was 8.3% (8/96 patients). Univariate analysis showed a significant association between the incidence of a POPF and the following factors: body mass index (BMI) (28: 12% vs. 43.5%, respectively, p = 0.014), pancreatic consistency (firm vs. soft: 16.7% vs. 44.4%, respectively, p = 0.036), pancreatic duct diameter (>3 mm vs. 28, soft pancreatic texture, small pancreatic duct diameter of ≤3 mm, and drain amylase level at POD 3 (cutoff point = 644 IU) were the most significant risk factors for the development of a POPF following pancreaticoduodenectomy. •Pancreatic fistula is a life-threatening complication after pancreaticoduodenectomy.•Many risk factors for development of postoperative pancreatic fistula.•High BMI, soft pancreatic consistency and small duct diameter are common risk factors.•High drain amylase level (>644 IU) is a significant risk factor.