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. 2018 Mar 1;31(1):e1345.
doi: 10.1590/0102-672020180001e1345.

DRAIN AMYLASE ON THE FIRST POSTOPERATIVE DAY OF WHIPPLE SURGERY: WHAT VALUE IS THE BEST PREDICTOR FOR EARLY DRAIN REMOVAL?

[Article in English, Portuguese]
Enio Campos Amico  1 , Ítalo Medeiros de Azevedo  1 , Marcos Vinicius de Lira Fernandes  1 , Mariane Albuquerque Reis  1 , Samir Assi João  1
Affiliations

DRAIN AMYLASE ON THE FIRST POSTOPERATIVE DAY OF WHIPPLE SURGERY: WHAT VALUE IS THE BEST PREDICTOR FOR EARLY DRAIN REMOVAL?

[Article in English, Portuguese]
Enio Campos Amico et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: The value of drain amylase on the first postoperative day after pancreatic resections has been described as an efficient predictor of pancreatic fistula. In spite of this, the cut-off point below which the drains can be removed early remains controversial.

Aim: Validate the use of the amylase on the 1st postoperative day in the correlation with pancreatic fistula and define the value at which early drain removal is safe.

Method: Were included patients undergoing Whipple surgery in the period of 2007 to 2016. Group 1 enrolled the ones who did not develop fistula and those who developed biochemical fistula for less than seven days postoperatively and group 2 included patients who developed persistent biochemical fistula between seven and 21 days and those with grade B and C fistula.

Results: Sixty-one patients were included, 41 comprised group 1 and 20 group 2. The incidence of abdominal collections, need for reoperation and time of hospitalization were for group 1 and 2, respectively: 17.1%, 17.1% and 9.5 days, and 65%, 40% and 21.1 days. The median of the amylase from the drain at 1st postoperative day was in group 1 and 2, respectively: 175 U/l and 3172.5 U/l (p=0.001). Using a cut-off of 180 to predict the group to which the patient would belong there was obtained sensitivity, specificity, positive predictive value and negative predictive value of 100%, 48.8%, 50% and 100% respectively.

Conclusion: It was validated the cut-off value of 180 U/l as appropriate to early drain removal.

Racional:: O valor da amilase do dreno no primeiro dia pós-operatório após ressecções pancreáticas é descrito como eficiente preditor de fístula pancreática. Entretanto, o valor abaixo do qual os drenos podem ser removidos precocemente permanece controverso.

Objetivo:: Validar o uso da amilase do primeiro dia pós-operatório na correlação com a fístula pancreática e definir o valor em que seja segura a retirada precoce do dreno.

Método:: Foram incluídos pacientes submetidos à operação de Whipple no período de 2007 a 2016. No grupo 1 entraram os que não desenvolveram fístula e os que desenvolveram fístula bioquímica por menos de sete dias de pós-operatório e no grupo 2 os que desenvolveram fístula bioquímica persistente entre 7 e 21 dias e aqueles com fístula grau B e C.

Resultados:: Sessenta e um pacientes foram incluídos, sendo 41 do grupo 1 e 20 do grupo 2. A incidência de coleções abdominais, necessidade de reoperação e tempo de internação foram para o grupo 1 e 2, respectivamente 17,1%, 17,1% e 9,5 dias, e 65%, 40% e 21,1 dias. A mediana da amilase no grupo 1 e 2, respectivamente foi de 175 U/l e 3172,5 U/l (p=0,001). Utilizando o ponto de corte de 180 para predizer o grupo a que o paciente pertenceria, obteve-se sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de: 100%, 48,8%, 50% e 100% respectivamente.

Conclusão:: Esta amostra pôde validar o ponto de corte de 180 U/l como adequado para a retirada precoce do dreno.

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Conflict of interest statement

Conflict of interest: none

References

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