背景:胰十二指肠切除术后早期发热与临床相关的术后胰瘘(CR-POPF)之间的联系尚不清楚。本研究旨在探讨这种关联,并评估CR-POPF术后早期发热的预测价值。
方法:这项回顾性观察性研究包括2007年至2019年在三级教学医院接受胰十二指肠切除术的成年患者。患者分为术后早期发热(术后前48小时≥38°C)和无术后早期发热组。使用稳定的治疗加权逆概率(sIPTW)和多变量逻辑分析进行加权逻辑回归分析。计算受试者工作特征曲线的c统计量,以评估将术后早期发热添加到先前确定的CR-POPF预测因子对预测能力的影响。
结果:在分析的1997年患者中,909(45.1%)发生术后早期发热。所有患者中CR-POPF的总发生率为14.3%,术后早期发热组的发生率为19.5%,无术后早期发热组的发生率为9.9%。术后早期发热与sIPTW后CR-POPF的高风险显著相关(调整后比值比[OR],1.73;95%置信区间[CI],1.34-2.22;P<0.001)和多变量logistic回归分析(调整后的OR,1.88;95%CI,1.42-2.49;P<0.001)。有或没有术后早期发热的模型的c统计量分别为0.76(95%CI,0.73-0.79)和0.75(95%CI,0.72-0.78),分别,显示出两者之间的显著差异(差异,0.02;95%CI,0.00-0.03;德隆检验,P=0.005)。
结论:术后早期发热是胰十二指肠切除术后CR-POPF的重要预测因子,但不是很明显。然而,它的广泛出现限制了它作为预测标记的适用性。
BACKGROUND: The connection between early postoperative
fever and clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy remains unclear. This study aimed to investigate this association and assess the predictive value of early postoperative
fever for CR-POPF.
METHODS: This retrospective observational study included adult patients who underwent pancreaticoduodenectomy at a tertiary teaching hospital between 2007 and 2019. Patients were categorized into those with early postoperative
fever (≥ 38 °C in the first 48 h after surgery) and those without early postoperative
fever groups. Weighted logistic regression analysis using stabilized inverse probability of treatment weighting (sIPTW) and multivariable logistic analysis were performed. The c-statistics of the receiver operating characteristic curves were calculated to evaluate the impact on the predictive power of adding early postoperative fever to previously identified predictors of CR-POPF.
RESULTS: Of the 1997 patients analyzed, 909 (45.1%) developed early postoperative fever. The overall incidence of CR-POPF among all the patients was 14.3%, with an incidence of 19.5% in the early postoperative fever group and 9.9% in the group without early postoperative
fever. Early postoperative fever was significantly associated with a higher risk of CR-POPF after sIPTW (adjusted odds ratio [OR], 1.73; 95% confidence interval [CI], 1.34-2.22; P < 0.001) and multivariable logistic regression analysis (adjusted OR, 1.88; 95% CI, 1.42-2.49; P < 0.001). The c-statistics for the models with and without early postoperative fever were 0.76 (95% CI, 0.73-0.79) and 0.75 (95% CI, 0.72-0.78), respectively, showing a significant difference between the two (difference, 0.02; 95% CI, 0.00-0.03; DeLong\'s test, P = 0.005).
CONCLUSIONS: Early postoperative fever is a significant but not highly discriminative predictor of CR-POPF after pancreaticoduodenectomy. However, its widespread occurrence limits its applicability as a predictive marker.