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External validation of postoperative pancreatic fistula prediction scores in pancreatoduodenectomy : a systematic review and meta-analysis

Pande, Rupaly ; Halle-Smith, James M. ; Phelan, Liam ; Thorne, Thomas ; Panikkar, M. ; Hodson, James ; Roberts, Keith J. ; Arshad, Ali ; Connor, Saxon and Conlon, Kevin CP , et al. (2022) In HPB 24(3). p.287-298
Abstract

Background: Multiple risk scores claim to predict the probability of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy. It is unclear which scores have undergone external validation and are the most accurate. The aim of this study was to identify risk scores for POPF, and assess the clinical validity of these scores. Methods: Areas under receiving operator characteristic curve (AUROCs) were extracted from studies that performed external validation of POPF risk scores. These were pooled for each risk score, using intercept-only random-effects meta-regression models. Results: Systematic review identified 34 risk scores, of which six had been subjected to external validation, and so included in the meta-analysis, (Tokyo... (More)

Background: Multiple risk scores claim to predict the probability of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy. It is unclear which scores have undergone external validation and are the most accurate. The aim of this study was to identify risk scores for POPF, and assess the clinical validity of these scores. Methods: Areas under receiving operator characteristic curve (AUROCs) were extracted from studies that performed external validation of POPF risk scores. These were pooled for each risk score, using intercept-only random-effects meta-regression models. Results: Systematic review identified 34 risk scores, of which six had been subjected to external validation, and so included in the meta-analysis, (Tokyo (N=2 validation studies), Birmingham (N=5), FRS (N=19), a-FRS (N=12), m-FRS (N=3) and ua-FRS (N=3) scores). Overall predictive accuracies were similar for all six scores, with pooled AUROCs of 0.61, 0.70, 0.71, 0.70, 0.70 and 0.72, respectively. Considerably heterogeneity was observed, with I2 statistics ranging from 52.1-88.6%. Conclusion: Most risk scores lack external validation; where this was performed, risk scores were found to have limited predictive accuracy. Consensus is needed for which score to use in clinical practice. Due to the limited predictive accuracy, future studies to derive a more accurate risk score are warranted.

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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
HPB
volume
24
issue
3
pages
287 - 298
publisher
Elsevier
external identifiers
  • pmid:34810093
  • scopus:85119427128
ISSN
1365-182X
DOI
10.1016/j.hpb.2021.10.006
language
English
LU publication?
yes
id
24423fc4-d8b6-4ab3-926d-34b9c85624a6
date added to LUP
2021-12-13 13:40:03
date last changed
2025-07-14 10:24:54
@article{24423fc4-d8b6-4ab3-926d-34b9c85624a6,
  abstract     = {{<p>Background: Multiple risk scores claim to predict the probability of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy. It is unclear which scores have undergone external validation and are the most accurate. The aim of this study was to identify risk scores for POPF, and assess the clinical validity of these scores. Methods: Areas under receiving operator characteristic curve (AUROCs) were extracted from studies that performed external validation of POPF risk scores. These were pooled for each risk score, using intercept-only random-effects meta-regression models. Results: Systematic review identified 34 risk scores, of which six had been subjected to external validation, and so included in the meta-analysis, (Tokyo (N=2 validation studies), Birmingham (N=5), FRS (N=19), a-FRS (N=12), m-FRS (N=3) and ua-FRS (N=3) scores). Overall predictive accuracies were similar for all six scores, with pooled AUROCs of 0.61, 0.70, 0.71, 0.70, 0.70 and 0.72, respectively. Considerably heterogeneity was observed, with I2 statistics ranging from 52.1-88.6%. Conclusion: Most risk scores lack external validation; where this was performed, risk scores were found to have limited predictive accuracy. Consensus is needed for which score to use in clinical practice. Due to the limited predictive accuracy, future studies to derive a more accurate risk score are warranted.</p>}},
  author       = {{Pande, Rupaly and Halle-Smith, James M. and Phelan, Liam and Thorne, Thomas and Panikkar, M. and Hodson, James and Roberts, Keith J. and Arshad, Ali and Connor, Saxon and Conlon, Kevin CP and Dickson, Euan J. and Giovinazzo, Francesco and Harrison, Ewen and de Liguori Carino, Nicola and Hore, Todd and Knight, Stephen R. and Loveday, Benjamin and Magill, Laura and Mirza, Darius and Pandanaboyana, Sanjay and Perry, Rita J. and Pinkney, Thomas and Siriwardena, Ajith K. and Satoi, Sohei and Skipworth, James and Stättner, Stefan and Sutcliffe, Robert P. and Tingstedt, Bobby}},
  issn         = {{1365-182X}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{287--298}},
  publisher    = {{Elsevier}},
  series       = {{HPB}},
  title        = {{External validation of postoperative pancreatic fistula prediction scores in pancreatoduodenectomy : a systematic review and meta-analysis}},
  url          = {{http://dx.doi.org/10.1016/j.hpb.2021.10.006}},
  doi          = {{10.1016/j.hpb.2021.10.006}},
  volume       = {{24}},
  year         = {{2022}},
}