Positive drain fluid culture on postoperative day one is associated with an increased risk of late postoperative pancreatic fistula after pancreaticoduodenectomy.

PURPOSE

To investigate the risk factors for late postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD), with a focus on positive drain fluid culture (DFC) results on postoperative day (POD) 1.

METHODS

Medical records of 198 patients who underwent PD with drain fluid amylase (DFA) on POD 5 < 3x upper limit of normal (ULN) were included. Late POPF was defined as POPF diagnosed post-POD 6, with DFA on POD 5 < 3xULN. Risk factors analyses were performed, with a focus on DFC on POD 1.

RESULTS

Nineteen patients (9.6%) were diagnosed with late POPF. Age > 65 years (OR: 4.019, P = 0.034) and positive DFC on POD 1 (OR: 10.151, P < 0.001) were identified as independent predictors of late POPF. Patients with positive DFC on POD 1 (n = 25) had higher rates of late POPF (44% vs. 4.6%, P < 0.001), postpancreatectomy hemorrhage (20% vs. 5.8%, P = 0.027) and Clavien-Dindo ≥ IIIa complications (44% vs. 6.4%, P < 0.001). The majority of patients (57.9%) with late POPF had positive DFC on POD 1 (11 of 19, 57.9%). The isolates from 11 patients with positive DFC on POD 1 yielded 12 microorganisms, the most prevalent of which were Enterobacter (n = 7), followed by Enterococcus (n = 3) and Staphylococcus (n = 2). Cefmetazole resistance was detected in 66.7% (8 of 12) of the microorganisms.

CONCLUSION

Age > 65 years and positive DFC on POD 1 were independent predictors of late POPF after PD. Positive DFC on POD 1 was associated with a higher rate of complications.