251 Prospective Audit of Protocol CT Scans in Asymptomatic High-Risk Patients with Postoperative Pancreatic Fistula After Pancreatoduodenectomy

Abstract Aim Early intervention for patients with CR-POPF after pancreatoduodenectomy (PD) may improve outcomes. Our aim was to evaluate the impact of protocol CT scans in asymptomatic POPF patients. Method Since September 2022, protocol CT scans were performed in POPF patients at high-risk of progression to CR-POPF ("CR score" > 5, based on gender, POD3-drain amylase, POD3-serum albumin, POD3-serum CRP) after PD. The effect of this policy was evaluated by comparing outcomes between historical controls (Jan 2020-August 2022) and a prospective cohort (September 2022-Dec 2024): data collected included number/timing of CT scans; type/timing of interventions; complications; hospital stay. Results The study cohort included 437 consecutive patients who underwent PD (2020-24). Incidence of CR-POPF was 17.4% and 90-d mortality was 4.6%. 130 patients with POPF were diagnosed by DFA-POD3, including 44 who were high-risk of CR-POPF (historical 13, prospective 31). Positive findings were present on protocol CT scans in 17/24 (70.8%) asymptomatic POPF patients, of whom 13 (76.5%) underwent invasive intervention within 13 days (IQR 10.5-16). In CR-POPF patients, the prospective cohort were scanned earlier than historical controls (median 5 v. 8 days; p<0.001) and underwent earlier invasive intervention (10 v. 12.5 days; p=0.03). There was no difference in postoperative LOS (21 v. 17 days; p=0.57) or 90-day mortality (19.5% v. 14.3%; p=0.76) in CR-POPF patients between groups. Conclusions Implementation of protocol CT scans in high-risk POPF patients after PD was associated with earlier CT scans and invasive interventions, although this did not translate into reduced hospital stay or mortality. Larger, prospective studies are recommended.