Clinical and Financial Validation of the International Study Group for Pancreatic Surgery (ISGPS) Definition of Post-pancreatectomy Acute Pancreatitis (PPAP)
Elisa Bannone, Alice Cattelani, Gaetano Corvino, Alessio Marchetti, Valentina Andreasi, Francesca Fermi, Stefano Partelli, Nicolò Pecorelli, Domenico Tamburrino, Alessandro Esposito, Giuseppe Malleo, Manish Bhandare, Kaival Gundavda, Kuirong Jiang, Zipeng Lu, Jie Yin, Harish Lavu, Rosa Klotz, Daniela Merz, Christoph Michalski, Ulla Klaiber, Marco Montorsi, Gennaro Nappo, Naoki Ikenaga, Pasquale Scornamiglio, Bodil Andersson, Fraser Jeffery, Daniel Halloran, Robert Padbury, Ajith K. Siriwardena, Savio George Barreto, Luca Gianotti, Attila Oláh, Christopher Halloran, Saxon Connor, Roland Andersson, Jakob R. Izbicki, Masafumi Nakamura, Alessandro Zerbi, Mohammad Abu Hilal, Martin Loos, Charles J. Yeo, Yi Miao, Massimo Falconi, Christos Dervenis, John P. Neoptolemos, Markus W. Büchler, Marc G. Besselink, Cristina R. Ferrone, Thilo Hackert, Roberto Salvia, Shailesh V. Shrikhande, Oliver Strobel, Jens Werner, Christopher L. Wolfgang, Giovanni Marchegiani, for the International Study Group for Pancreatic Surgery (ISGPS)
Abstract
OBJECTIVE: To validate the International Study Group for Pancreatic Surgery (ISGPS) definition and grading system of post-pancreatectomy acute pancreatitis (PPAP) after pancreatoduodenectomy (PD). BACKGROUND: In 2022, the ISGPS defined 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 3 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 [interquartile range (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 courses, respectively ( 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.