Risk Factors for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: A Single-Center Experience

Background: Postoperative pancreatic fistula (POPF) is a common and clinically significant complication following pancreaticoduodenectomy (PD), contributing to increased morbidity, prolonged hospitalization, and mortality. This study aimed to determine the incidence and independent predictors of POPF in a tertiary care setting in Bangladesh. Methods: This prospective observational study included 100 consecutive patients who underwent PD at Dhaka Medical College Hospital from January to December 2024. Patients were classified into POPF and non-POPF groups based on the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria. Preoperative, intraoperative, and postoperative variables were analyzed. Multivariate logistic regression was performed to identify independent predictors of POPF. Results: POPF occurred in 28% of patients, with clinically relevant POPF (Grade B/C) accounting for 18%. On multivariate analysis, soft pancreatic texture (adjusted OR: 5.21, 95% CI: 1.73-15.68), pancreatic duct diameter < 3 mm (adjusted OR: 4.36, 95% CI: 1.52-12.47), serum albumin < 32 g/L (adjusted OR: 3.02, 95% CI: 1.11-8.19), elevated CRP > 20 mg/L (adjusted OR: 2.94, 95% CI: 1.04-8.28), and operative duration > 360 minutes (adjusted OR: 2.76, 95% CI: 1.01-7.51) were independent predictors of POPF. Patients with POPF had longer hospital stay (18.6 ± 6.2 vs. 11.9 ± 4.1 days) and higher mortality (14.3% vs. 2.8%). However, mortality was likely multifactorial and not solely attributable to POPF. Conclusion: POPF remains a frequent complication after PD. Soft pancreatic texture, small duct diameter, hypoalbuminemia, elevated CRP, and prolonged operative time are significant independent predictors. Although POPF is associated with adverse postoperative outcomes, its relationship with mortality is likely indirect. Preoperative optimization and meticulous surgical technique may reduce POPF incidence and improve outcomes. Further multicenter studies are required for external validation.