Four intraoperative factors predict the risk of clinically relevant post-operative pancreatic fistula (POPF) after pancreaticoduodenectomy. Guides drain placement, octreotide use, and anastomotic technique.
| Score | Risk Category | POPF Rate | Clinical Action |
|---|---|---|---|
| 0 | Negligible | ~0% | Routine; consider no drain |
| 1–2 | Low | ~6.6% | Standard drain; POD3 removal if amylase normal |
| 3–6 | Intermediate | ~12.9% | Maintain drain; octreotide; serial amylase |
| 7–10 | High | ~28.1% | Maintain drain; prophylactic measures; CT if not settling |
| Factor | Value | Points |
|---|---|---|
| Gland texture | Firm | 0 |
| Gland texture | Soft | 2 |
| Duct diameter | ≥5 mm | 0 |
| Duct diameter | 4 mm | 1 |
| Duct diameter | 3 mm | 2 |
| Duct diameter | 2 mm | 3 |
| Duct diameter | ≤1 mm | 4 |
| Pathology | PDAC / pancreatitis | 0 |
| Pathology | Ampullary / duodenal / cystic | 2 |
| Pathology | Other | 1 |
| Blood loss | ≤400 mL | 0 |
| Blood loss | 401–700 mL | 1 |
| Blood loss | 701–1000 mL | 2 |
| Blood loss | >1000 mL | 3 |