Perioperative Predictive Factors for Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy

Background and Objectives: Postoperative pancreatic fistula (POPF) remains the most significant cause of morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to identify comprehensive perioperative predictive factors for clinically relevant POPF (CR-POPF) in a cohort of 112 patients at a specialized center in Upper Egypt, incorporating a wide range of demographic, operative, laboratory, and pathological variables. Methods A retrospective analysis was conducted on 112 consecutive patients who underwent PD at the Liver and GIT Hospital, Minia University, between 2018 and 2025. CR-POPF was defined according to the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria (Grades B and C). All variables from the clinical database, including comorbidities, preoperative interventions, detailed operative metrics, and postoperative biochemical markers, were analyzed using univariate and multivariate logistic regression. Results The incidence of CR-POPF was 23.2% (26/112). Multivariate analysis identified soft pancreatic texture (OR 5.12, p < 0.001), pancreatic duct diameter ≤ 3 mm (OR 4.85, p < 0.001), BMI ≥ 25 kg/m² (OR 6.24, p = 0.001), operative time > 360 min (OR 3.64, p = 0.003), periampullary pathology (OR 3.47, p = 0.012), and blood loss > 800 mL (OR 2.89, p = 0.017) as independent predictors. Postoperatively, a POD 1 drain amylase > 1500 U/L (OR 11.42, p < 0.001) and POD 1 serum amylase > 200 U/L (OR 8.42, p < 0.001) were highly predictive. CR-POPF was significantly associated with increased rates of hemorrhage (23.1%), intra-abdominal abscess (46.2%), and prolonged hospital stay (28.4 days). Conclusion A combination of patient-specific, pancreas-specific, and operative factors comprehensively predicts the risk of CR-POPF. Early postoperative biochemical markers, particularly drain amylase, provide excellent diagnostic accuracy for timely intervention.