Improving the failure-to-rescue rate (ie, the mortality rate of patients who have major postoperative complications), is an important priority for surgical quality improvement.1,2 Pancreatic resections are complex operations with a high risk of postoperative complications. One of the most common complications after pancreatic surgery is postoperative pancreatic fistula (POPF). The incidence of POPF ranges from 3% to 45% at high-volume institutions. POPF can lead to further devastating complications, such as bleeding requiring intervention, multiple organ failure, and mortality. Grade B POPF requires a change in management postoperatively, with prolonged surgical drainage for at least 3 weeks, or endoscopic or percutaneous drain repositioning. Grade C POPF requires reoperation, or it will lead to single or multiple organ failure, or to mortality.3 Previous observational studies4-6 have shown that mortality after pancreatic resection is related to failure to rescue rather than to complications, have evaluated different diagnostic modalities for POPF, have identified factors associated with POPF (eg, body temperature, C-reactive protein, white blood cell count, serum amylase concentrations, drain amylase concentrations, non-serous drain efflux, and peripancreatic fluid collections seen on CT), and suggest that minimally invasive surgical strategies for the treatment of POPF are superior to reoperation.
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