For a study, the researchers sought to offer a wide range of individual patient presentations of pancreatic fistula risk and define the utility of mitigation techniques in some of the most common and vulnerable circumstances that surgeons face. About 5,533 PDs’ FRS characteristics and outcomes were collected from 17 worldwide organizations between 2003 and 2019. The FRS was used to create 80 different “scenarios” for patients. Risk-matched analyses with a Bonferroni correction were used to identify scenarios with a higher risk of CR-POPF incidence. The scenarios were then examined using multivariable regression to find the best mitigation strategies. The CR-POPF rate was 13.6% overall. All 80 conceivable possibilities were encountered, with scenario #1 (8.1%) — the only low-risk option (CR-POPF rate = 0.7%) – being the most common. The moderate-risk zone had the most scenarios (50), patients (N=3246), CR-POPFs (65.2%), and non-zero CR-POPF rate discrepancies between scenarios (18-fold). In the risk-matched study, 2 methods (#59 and 60) showed higher CR-POPF vulnerability than the moderate-risk zone (both P<0.001). In these cases, the multivariable analysis indicated the following factors to be related to CR-POPF: pancreaticogastrostomy reconstruction [odds ratio (OR) 4.67], omission of drain insertion (OR 5.51), and prophylactic octreotide (OR 3.09). When CR-POPF was compared to patients who did not use best practice strategies concurrently, there was a significant decrease (10.7% vs 35.5%, P<0.001; OR 0.20, 95% CI 0.12–0.33). A complete fistula risk catalog was built using the information, and the most clinically significant scenarios were identified. Individual methods give a practical approach to precision medicine, allowing for more targeted and efficient CR-POPF therapy.
