Villafane-Ferriol, N.Van Buren, G.Mendez-Reyes, J.E.McElhany, A.L.Massarweh, N.N.Silberfein, E.Hsu, C.Tran Cao, H.S.Schmidt, C.Zyromski, N.Dillhoff, M.Roch, A.Oliva, E.Smith, A.C.Zhang, Q.Fisher, W.E.2019-08-262019-08-262018-06Villafane-Ferriol, N., Van Buren, G., 2nd, Mendez-Reyes, J. E., McElhany, A. L., Massarweh, N. N., Silberfein, E. J., … Fisher, W. E. (2018). Sequential drain amylase to guide drain removal following pancreatectomy. HPB : the official journal of the International Hepato Pancreato Biliary Association, 20(6), 514–520. doi:10.1016/j.hpb.2017.11.008https://hdl.handle.net/1805/20574BACKGROUND: Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal. METHODS: Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test. RESULTS: Among 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B. CONCLUSIONS: In patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful.en-USPublisher PolicyAmylasesBiomarkersClinical enzyme testsDevice removalDrainagePancreatectomyPancreatic FistulaPancreaticoduodenectomyArticle