Recommended Citation
Armstrong R, Sami A, Lamptey M, et al. Predischarge CT Does Not Impact Detection Rate of Postoperative Pancreatic Fistula after Distal Pancreatectomy: A Community Quaternary Experience. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Post-operative pancreatic fistula (POPF) remains a challenging complication after distal pancreatectomy (DP). CT scan is commonly used to evaluate postop fluid collections/ POPF. We sought to identify predictive factors of POPF in our post-operative cohort with focus on patients who underwent post-operative CT due to suspicion for fistula at our institution.
Purpose:
The primary objective of this study was to evaluate the rate of POPF in all DP patients, and POPF in DP patients with negative post-operative CT (NegCT). We hypothesized that BMI (>30) would increase risk of NegCT in setting of POPF. The secondary objective of this analysis was to determine risk factors for pancreatic leak.
Methods:
A retrospective review of patients who underwent DP at community quaternary referral center was performed. Demographic information, operative details, and imaging data were collected for statistical analysis. Pearson’s Chi-squared test and multivariable logistic regression analysis were used for tests of significance.
Results:
158 patients underwent DP from 01/2017-12/2023; Of these patients, 32 (20%) developed clinically relevant (ISGPF Grade B/C) POPF. Most (63%, n = 99) had a CT scan within 90 days of surgery. Of these, 35 of 44 (80%) non-obese patients had NegCT compared to 37 of 55 (67%) obese patients. This difference was not statistically significant (p = 0.3). In patients with NegCT prior to discharge, 31% ultimately developed POPF (Grade A-C) compared to 22% with no CT prior to discharge (p = .02). LOS was greater in the NegCT pre-discharge vs. NoCT groups (median 7.0 [IQR 6-10] vs. 5.0 [4-6] days, p < 0.001). Factors associated with increased odds of pancreatic leak included higher BMI (OR 1.13 [95%CI 1.06-1.22] p < 0.001) and diabetes (OR 2.74 [1.05-7.82], p = 0.048). Younger age (OR 0.97 [0.94-1.00], p = 0.047) and decreased operative time (OR 0.96 [0.92-0.99], p = 0.027) were protective factors. Tobacco use had no significant effect (OR 1.29 [0.83-2.01], p = 0.3).
Conclusion:
POPF is a common complication of DP. Obesity was more common in patients with POPF but was less common in patients with occult POPF who had an initial NegCT. Clinical suspicion must remain high for early detection and management. A negative pre-discharge of CT was not associated with a decreased risk of POPF. Routine use of predischarge CT is not recommended for the early detection of POPF.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Predischarge CT Does Not Impact Detection Rate of Postoperative Pancreatic Fistula after Distal Pancreatectomy: A Community Quaternary Experience
Background/Significance:
Post-operative pancreatic fistula (POPF) remains a challenging complication after distal pancreatectomy (DP). CT scan is commonly used to evaluate postop fluid collections/ POPF. We sought to identify predictive factors of POPF in our post-operative cohort with focus on patients who underwent post-operative CT due to suspicion for fistula at our institution.
Purpose:
The primary objective of this study was to evaluate the rate of POPF in all DP patients, and POPF in DP patients with negative post-operative CT (NegCT). We hypothesized that BMI (>30) would increase risk of NegCT in setting of POPF. The secondary objective of this analysis was to determine risk factors for pancreatic leak.
Methods:
A retrospective review of patients who underwent DP at community quaternary referral center was performed. Demographic information, operative details, and imaging data were collected for statistical analysis. Pearson’s Chi-squared test and multivariable logistic regression analysis were used for tests of significance.
Results:
158 patients underwent DP from 01/2017-12/2023; Of these patients, 32 (20%) developed clinically relevant (ISGPF Grade B/C) POPF. Most (63%, n = 99) had a CT scan within 90 days of surgery. Of these, 35 of 44 (80%) non-obese patients had NegCT compared to 37 of 55 (67%) obese patients. This difference was not statistically significant (p = 0.3). In patients with NegCT prior to discharge, 31% ultimately developed POPF (Grade A-C) compared to 22% with no CT prior to discharge (p = .02). LOS was greater in the NegCT pre-discharge vs. NoCT groups (median 7.0 [IQR 6-10] vs. 5.0 [4-6] days, p < 0.001). Factors associated with increased odds of pancreatic leak included higher BMI (OR 1.13 [95%CI 1.06-1.22] p < 0.001) and diabetes (OR 2.74 [1.05-7.82], p = 0.048). Younger age (OR 0.97 [0.94-1.00], p = 0.047) and decreased operative time (OR 0.96 [0.92-0.99], p = 0.027) were protective factors. Tobacco use had no significant effect (OR 1.29 [0.83-2.01], p = 0.3).
Conclusion:
POPF is a common complication of DP. Obesity was more common in patients with POPF but was less common in patients with occult POPF who had an initial NegCT. Clinical suspicion must remain high for early detection and management. A negative pre-discharge of CT was not associated with a decreased risk of POPF. Routine use of predischarge CT is not recommended for the early detection of POPF.
Affiliations
Aurora St. Luke’s Medical Center, Aurora UW Medical Group, Aurora Sinai Medical Center