Clinical and Financial Validation of the International Study Group for Pancreatic Surgery (ISGPS) Definition of Post-Pancreatectomy Acute Pancreatitis (PPAP): International Multicenter Prospective Study

Alice Cattelani Masafumi Nakamura Werner Hartwig Asahi Sato Saxon Connor Roland Andersson Jakob R. Izbicki Attila Oláh Christopher M. Halloran Markus W. Büchler Marc G. Besselink Cristina Ferrone Thilo Hackert Martin Loos Roberto Salvia Daniel Kilburn Keith D. Lillemoe Oliver Strobel Jens Werner Mustapha Adham Charles Vollmer Nicholas J. Zyromski Gaetano Corvino Yi Miao Massimo Falconi Christos Dervenis John P. Neoptolemos Shailesh V. Shrikhande Elisa Bannone Nicolò Pecorelli Stefano Partelli Fraser Jeffery Daniel Halloran Marco Montorsi Harish Lavu Alessio Marchetti Valentina Andreasi Francesca Fermi Domenico Tamburrino Alessandro Esposito Giuseppe Malleo Manish Bhandare Kaival Gundavda Kuirong Jiang Zipeng Lu Savio George Barreto Luca Gianotti Alessandro Zerbi Mohammad Abu Hilal Charles J. Yeo Helmut Friess Jie Yin Rosa Klotz Daniela Merz Christoph Michalski Ulla Klaiber Gennaro Nappo Naoki Ikenaga Pasquale Scornamiglio Christopher L. Wolfgang Giovanni Marchegiani Maximillian Bockhorn Ugo Boggi Olivier R.C. Busch Kevin Christopher Conlon Abe Fingerhut Bodil Andersson Robert Padbury Ajith K. Siriwardena Giuseppe Kito Fusai Alberto Manzoni Dejan Radenkovic Michael Sarr Kyoichi Takaori

Publication Name: Annals of Surgery

Publication Date: 2024-01-01

Volume: Unknown

Issue: Unknown

Page Range: Unknown

Description:

Objective: To validate the ISGPS definition and grading system of PPAP after pancreatoduodenectomy (PD). Summary Background Data: In 2022, the International Study Group for Pancreatic Surgery (ISGPS) defined post-pancreatectomy acute pancreatitis (PPAP) and recommended a prospective validation of its diagnostic criteria and grading system. Methods: This was a prospective, international, multicenter study including patients undergoing PD at 17 referral pancreatic centers across Europe, Asia, Oceania, and the United States. PPAP diagnosis required the following three parameters: (1) postoperative serum hyperamylasemia /hyperlipasemia (POH) persisting on postoperative days 1 and 2, (2) radiologic alterations consistent with PPAP, and (3) a clinically relevant deterioration in the patient's condition. To validate the grading system, clinical and economic parameters were analyzed across all grades. Results: Among 2902 patients undergoing PD, 7.5% (n=218) developed PPAP (6.3% grade B and 1.2% grade C). POH occurred in 24.1% of patients. Hospital stay was associated with PPAP grades (No POH/PPAP 10 days (IQR 7-17) days, grade B 22 days (IQR 15-34) days, and grade C 43 days (IQR 27-54) days; P<0.001), as well as intensive care unit admission (No POH/PPAP 5.4%, grade B 12.6%, grade C 82.9%; P<0.010), and hospital readmission rates (No POH/PPAP 7.3%, grade B 16.1%, grade C 18.5%; P<0.05). Costs of grade B and C PPAP were 2 and 11 times greater than uncomplicated clinical course, resp. (P<0.001). Conclusions: This first prospective, international validation study of the ISGPS definition and grading system for PPAP highlighted the relevant clinical and financial implications of this condition. These results stress the importance of routine screening for PPAP in patients undergoing PD.

Open Access: Yes

DOI: 10.1097/SLA.0000000000006569

Authors - 74

Alice Cattelani

57720010400

Masafumi Nakamura

36119245100

Werner Hartwig

35237162400

Asahi Sato

57104281400

Saxon Connor

7102767367

Roland Andersson

12771093400

Jakob R. Izbicki

54417289400

Attila Oláh

7006654752

Christopher M. Halloran

8778357100

Markus W. Büchler

55066608000

Marc G. Besselink

57214401117

Cristina Ferrone

57204305542

Thilo Hackert

55984566700

Martin Loos

57210119592

Roberto Salvia

6701399875

Daniel Kilburn

56236123500

Keith D. Lillemoe

26643471900

Oliver Strobel

55068064200

Jens Werner

7403266165

Mustapha Adham

7007177025

Charles Vollmer

57215788598

Nicholas J. Zyromski

6602679151

Gaetano Corvino

58181402600

Yi Miao

57208366180

Massimo Falconi

7006841625

Christos Dervenis

7003990635

John P. Neoptolemos

7102231480

Shailesh V. Shrikhande

7006060690

Elisa Bannone

57192231561

Nicolò Pecorelli

42762145100

Stefano Partelli

16687107300

Fraser Jeffery

57678053300

Daniel Halloran

59391197200

Marco Montorsi

57216735491

Harish Lavu

8579900300

Alessio Marchetti

57949475300

Valentina Andreasi

57197756501

Francesca Fermi

57427090900

Domenico Tamburrino

37032225200

Alessandro Esposito

56396179400

Giuseppe Malleo

13608518900

Manish Bhandare

56653404700

Kaival Gundavda

57218568586

Kuirong Jiang

14035778400

Zipeng Lu

35102831500

Savio George Barreto

36896756400

Luca Gianotti

36939859100

Alessandro Zerbi

7004367076

Mohammad Abu Hilal

57197168275

Charles J. Yeo

7102545542

Helmut Friess

36049095700

Jie Yin

57201574265

Rosa Klotz

57197546466

Daniela Merz

58134548800

Christoph Michalski

14058481900

Ulla Klaiber

56521655500

Gennaro Nappo

51764348900

Naoki Ikenaga

35444493300

Pasquale Scornamiglio

59391025900

Christopher L. Wolfgang

57218107225

Giovanni Marchegiani

57214806473

Maximillian Bockhorn

8431544700

Ugo Boggi

7006650849

Olivier R.C. Busch

55649116400

Kevin Christopher Conlon

35408417700

Abe Fingerhut

7101670085

Bodil Andersson

14007568700

Robert Padbury

6603924012

Ajith K. Siriwardena

7006352137

Giuseppe Kito Fusai

25629557900

Alberto Manzoni

53877953100

Dejan Radenkovic

6603592685

Michael Sarr

56056115900

Kyoichi Takaori

7004836243