Drain amylase values for clinically relevant post‐operative pancreatic fistulae

Abstract Aim This study aims to identify the cut‐off drain amylase (DA) values on the first, third, and fifth post‐operative days (POD1‐DA, POD3‐DA, and POD5‐DA) that are correlated with clinically relevant post‐operative pancreatic fistula (CR‐POPF). Patients and Methods All data were retrospectively collected from patients who underwent pancreatectomy at the Department of Surgery, Phramongkutklao Hospital, from January 2015 to December 2023. A total of 195 patients were included in the study. Results A total of 195 patients were analysed, including 35 patients with CR‐POPF, with a mean age of 60.84 years. There were no statistically significant differences in demographic data between patients with CR‐POPF and those without. In addition, no statistical differences were observed in pancreatic duct diameter (3 mm vs 2 mm), operative time (468.9 min vs 500.29 min), or blood loss (600 mL vs 600 mL) between the CR‐POPF and no CR‐POPF groups. Length of hospital stays was longer in the CR‐POPF group compared with the no CR‐POPF group (33 days vs 11 days, P = .001). In addition, the CR‐POPF group had significantly higher rates of post‐operative pancreatic haemorrhage (20% vs 2.5%), bile leakage (5.71% vs 0%), delayed gastric emptying (45.71% vs 3.13%), wound complications (34.29% vs 5%), and mortality (17.14% vs 1.88%) compared with the no CR‐POPF group. The optimal cut‐off values for CR‐POPF were 1313 U/L on day 1 (D1; area under the curve [AUC] 0.72, 95% confidence interval [CI] 0.65–0.84, sensitivity 91%, specificity 52%), 492 U/L on D3 (AUC 0.77, 95% CI 0.70–0.83, sensitivity 91%, specificity 64%), and 360 U/L on D5 (AUC 0.65, 95% CI 0.52–0.75, sensitivity 69%, specificity 61%). There were no significant perioperative factors associated with CR‐POPF in our study. Conclusion DA levels of 1313, 492, and 360 U/L on post‐operative D1, D3, and D5, respectively, were associated with CR‐POPF. Drain removal can be safely performed without the risk of CR‐POPF when these levels are met.