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Gautam Sharma*1, Chao Tu1,2, Essa M. Aleassa1, Gareth Morris-Stiff1
1General Surgery, Cleveland Clinic, Cleveland, OH; 2Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH

Purpose: Postoperative day one drain fluid amylase (DFA-1) levels in patients undergoing pancreatoduodenectomy (PD) have been used to predict the subsequent development of a postoperative pancreatic fistula (POPF). However, literature with respect to the association of DFA levels with additional complications is limited. Our aim was to interrogate a national database to assess if early DFA-1 levels ≥ 5000 U/l could be utilized to predict 30-day complications in addition to POPF after PD.

Methods: The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) pancreatectomy targeted files were queried from 2014-2016 to identify patients who underwent PD. Only patients with a recorded DFA-1 level were included for analysis.

Results: Of 2543 patients with DFA-1 levels, 422 patients (17 %) had DFA-1 levels ≥ 5000 U/l. Among the patients with available DFA-1 levels, most common early 30-day complications included: POPF (n=430, 17%), delayed gastric emptying (n=398, 16%), organ space SSI (n=286, 11%) and intraoperative or early postoperative transfusion with 72 hours (n=416, 16%). On multivariate analysis in patients with POPF, DFA-1 levels ≥ 5000 U/l were associated with organ space surgical site infection (SSI) (OR: 2.0, p<0.001) and delayed gastric emptying (OR: 1.5, p=0.002). However, after eliminating patients with POPF from the analysis, DFA-1 levels ≥ 5000 U/l were still associated with development of organ space SSI (OR: 2.4, p<0.001).

Conclusion: Early postoperative drain fluid amylase level is a useful tool to predict organ space infection. In this cohort a selective imaging policy may allow early intervention and prevent readmission.

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