为了通过外部验证评估已发布的瘘管风险模型的性能，并确定术后胰腺瘘 (POPF) 的独立风险因素。已开发出多种预测胰十二指肠切除术后 POPF 的风险模型。然而，高质量前瞻性队列的外部验证尚不足或仅针对个体模型执行。进行了一项后观察数据分析来自 stepped-wedge 群集随机 PORSCH 试验的数据。包括荷兰 (2018 年 1 月至 2019 年 11 月) 所有接受胰十二指肠切除术的患者。通过系统性文献搜索，确定了有关 POPF 的风险模型。通过计算接收器操作曲线下面积 (AUC) 和校准图评估模型性能。进行多变量 Logistic 回归以确定与临床相关的 POPF 的独立风险因素。总体而言，共纳入 1358 名接受胰十二指肠切除术的患者中，341 名患者 (25%) 发生了临床相关的 POPF。评估了 14 个 POPF 风险模型，其 AUC 范围从 0.62-0.70。通过更新的替代瘘管风险评分，其 AUC 为 0.70 (95% CI 0.69-0.72)。而 Petrova 等人的模型也显示了 0.70 的 AUC (95% CI 0.69-0.71)。独立预测 POPF 的因素包括软的胰腺质地、除胰管腺癌或慢性胰腺炎之外的病理学、小的胰管直径、较高的身体质量指数、微创切除和男性性别。预测临床相关的 POPF 的已发布风险模型具有中等预测准确性。因此，它们的临床适用性来识别高风险患者并指导治疗策略是有问题的。 版权所有©2023 Wolters Kluwer Health,Inc.保留所有权利。

To evaluate the performance of published fistula risk models by external validation, and to identify independent risk factors for postoperative pancreatic fistula (POPF).Multiple risk models have been developed to predict POPF after pancreatoduodenectomy. External validation in high-quality prospective cohorts is, however, lacking or only performed for individual models.A post-hoc analysis of data from the stepped-wedge cluster randomized PORSCH trial was performed. Included were all patients undergoing pancreatoduodenectomy in the Netherlands (January 2018-November 2019). Risk models on POPF were identified by a systematic literature search. Model performance was evaluated by calculating the area under the receiver operating curves (AUC) and calibration plots. Multivariable logistic regression was performed to identify independent risk factors associated with clinically relevant POPF.Overall, 1358 patients undergoing pancreatoduodenectomy were included, of whom 341 patients (25%) developed clinically relevant POPF. Fourteen risk models for POPF were evaluated, with AUCs ranging from 0.62-0.70. The updated alternative fistula risk score had an AUC of 0.70 (95% CI 0.69-0.72). The alternative fistula risk score demonstrated an AUC of 0.70 (95% CI 0.68-0.71), whilst an AUC of 0.70 (95% CI 0.69-0.71) was also found for the model by Petrova et al Soft pancreatic texture, pathology other than pancreatic ductal adenocarcinoma or chronic pancreatitis, small pancreatic duct diameter, higher body-mass index, minimally invasive resection and male sex were identified as independent predictors of POPF.Published risk models predicting clinically relevant POPF after pancreatoduodenectomy have a moderate predictive accuracy. Their clinical applicability to identify high-risk patients and guide treatment strategies is therefore questionable.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.