Defining the post-operative morbidity index for distal pancreatectomy

Major K. Lee, Russell S. Lewis, Steven M. Strasberg, Bruce L. Hall, John D. Allendorf, Joal D. Beane, Stephen W. Behrman, Mark P. Callery, John D. Christein, Jeffrey A. Drebin, Irene Epelboym, Jin He, Henry A. Pitt, Emily Winslow, Christopher Wolfgang, Charles M. Vollmer

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Accurate assessment of complications is critical in analysing surgical outcomes. The post-operative morbidity index (PMI), derived from the Modified Accordion Severity Grading System and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), is a quantitative measure of post-operative morbidity. This study utilizes PMI to establish the complication burden for a distal pancreatectomy (DP). Methods: From 2005-2011, nine centres contributed ACS-NSQIP complication data for 655 DPs. Each complication was assigned an Accordion severity weight ranging from 0.11 for grade 1 to 1.00 for grade 6 (death). The PMI is the sum of complication severity weights divided by the total number of patients. Results: ACS-NSQIP complications occurred in 177 patients (27.0%). The non risk-adjusted PMI for DP is 0.087. Bleeding/Transfusion and Organ Space Infection were the most common complications. Frequency and burden differed across Accordion grades. While grade 4-6 complications represented only 15.4% of complication occurrences, they accounted for 30.4% of the burden. Subgroup analysis demonstrates that the PMI did not vary based on laparoscopic versus open approach or the performance of a splenectomy. Discussion: This study uses two validated systems to quantitatively establish the morbidity of a DP. The PMI allows estimation of both the frequency and severity of complications and thus provides a more comprehensive assessment of risk.

Original languageEnglish (US)
Pages (from-to)915-923
Number of pages9
JournalHPB
Volume16
Issue number10
DOIs
StatePublished - 2014

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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