Abstract Background Highly utilized risk scores for clinically relevant postoperative pancreatic fistula (CR-POPF) have guided clinical decision-making in pancreatoduodenectomy. However, none has been successfully developed for distal pancreatectomy. This study aimed to develop and validate a new fistula risk score for distal pancreatectomy. Methods Patients undergoing distal pancreatectomy at Helsinki University Hospital, Finland from 2013 to 2021, and at Karolinska University Hospital, Sweden, from 2010 to 2020, were included retrospectively. The outcome was CR-POPF, according to the 2016 International Study Group of Pancreatic Surgery definition. Preoperative clinical demographics and radiological parameters such as pancreatic thickness and duct diameter were measured. A logistic regression model was developed, internally validated with bootstrapping, and the performance assessed in an external validation cohort. Results Of 668 patients from Helsinki (266) and Stockholm (402), 173 (25.9 per cent) developed CR-POPF. The final model consisted of three variables assessed before surgery: transection site (neck versus body/tail), pancreatic thickness at transection site, and diabetes. The model had an area under the receiver operating characteristic curve (AUROC) of 0.904 (95 per cent c.i. 0.855 to 0.949) after internal validation, and 0.798 (0.748 to 0.848) after external validation. The calibration slope and intercept on external validation were 0.719 and 0.192 respectively. Four risk groups were defined in the validation cohort for clinical applicability: low (below 5 per cent), moderate (at least 5 but below 30 per cent), high (at least 30 but below 75 per cent), and extreme (75 per cent or more). The incidences in these groups were 8.7 per cent (11 of 126), 22.0 per cent (36 of 164), 63 per cent (57 of 91), and 81 per cent (17 of 21) respectively. Conclusion The DISPAIR score after distal pancreatectomy may guide decision-making and allow a risk-adjusted outcome comparison for CR-POPF.

中文翻译：

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远端胰腺切除术后临床相关术后胰瘘风险的 DISPAIR 瘘管风险评分的开发和外部验证

摘要 背景高度利用的临床相关术后胰瘘（CR-POPF）风险评分指导了胰十二指肠切除术的临床决策。然而，尚未成功开发出用于远端胰腺切除术的技术。本研究旨在开发和验证远端胰腺切除术的新瘘管风险评分。 方法回顾性纳入 2013 年至 2021 年在芬兰赫尔辛基大学医院和 2010 年至 2020 年在瑞典卡罗林斯卡大学医院接受远端胰腺切除术的患者。根据 2016 年国际胰腺外科研究组的定义，结果为 CR-POPF。测量术前临床人口统计学和放射学参数，例如胰腺厚度和导管直径。开发了逻辑回归模型，通过引导进行内部验证，并在外部验证队列中评估性能。 结果在来自赫尔辛基 (266) 和斯德哥尔摩 (402) 的 668 名患者中，173 名 (25.9%) 患有 CR-POPF。最终模型由手术前评估的三个变量组成：横断部位（颈部与身体/尾部）、横断部位的胰腺厚度和糖尿病。内部验证后，该模型的受试者工作特征曲线下面积 (AUROC) 为 0.904（95% CI 0.855 至 0.949），外部验证后为 0.798（0.748 至 0.848）。外部验证的校准斜率和截距分别为 0.719 和 0.192。在临床适用性验证队列中定义了四个风险组：低（低于 5%）、中度（至少 5% 但低于 30%）、高（至少 30% 但低于 75%）和极端（75%）。分或更多）。这些组的发生率分别为 8.7%（126 例中的 11 例）、22.0%（164 例中的 36 例）、63%（91 例中的 57 例）和 81%（21 例中的 17 例）。 结论远端胰腺切除术后的 DISPAIR 评分可以指导决策并允许对 CR-POPF 进行风险调整后的结果比较。