Validation of the Fistula Risk Score for Post-operative Pancreatic Fistula After Pancreatoduodenectomy

The fistula risk score (FRS) has been developed to predict clinically relevant postoperative pancreatic fistula (CR-POPF). This study aimed to validate its applicability in patients undergoing pancreatoduodenectomy at a tertiary care teaching centre in northern India. Historical records of 105 patients who underwent pancreatoduodenectomy between January 2010 and December 2017 were reviewed. The FRS was calculated for each patient based on operative records. Various outcome parameters, including POPF, were evaluated across four discrete risk zones. The performance of the model was assessed by area under the receiver operating curve. Based on FRS, patients were grouped into 4 risk zones: Group A (negligible risk, score 0): 4 patients (3.8%); Group B (low risk, score 1–2): 35 patients (33.3%); Group C (moderate risk, score 3–6): 54 patients (51.4%), and Group D (high risk, score 7–10): 12 patients (11.4%). Overall incidence of CR-POPF was 15.2%. The incidence of CR-POPF in negligible, low, moderate, and high-risk patients was 0%, 8.5%, 14.8%, and 41.6%, respectively (p = 0.003). Increasing FRS correlated well with the CR-POPF development on univariate (p < 0.03) and multivariate (p < 0.04) analysis. Upon assessing the model performance for fistula risk zones using area under the receiver operating curve, an overall result of 0.80 (95 CI 0.71–0.87) was obtained, indicating good ability of the FRS to predict the development of CR-POPF. This single institutional experience validates FRS as a good and reliable tool for predicting the development of CR-POPF after pancreatoduodenectomy. This study affirms its universal applicability.