Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy: A novel scoring system

Raghunandan Venkat, Milo A. Puhan, Richard D. Schulick, John L Cameron, Frederic Eckhauser, Michael A. Choti, Martin A Makary, Timothy M. Pawlik, Nita Ahuja, Barish H. Edil, Christopher Wolfgang

Research output: Contribution to journalArticle

Abstract

Objective: To develop and validate a risk score to predict the 30- and 90-day mortality after a pancreaticoduodenectomy or total pancreatectomy on the basis of preoperative risk factors in a high-volume program. Design: Datafroma prospectively maintained institutional database were collected. In a random subset of 70% of patients (training cohort), multivariate logistic regression was used to develop a simple integer score, which was then validated in the remaining 30% of patients (validation cohort). Discrimination and calibration of the score were evaluated using area under the receiver operating characteristic curve and Hosmer-Lemeshow test, respectively. Setting: Tertiary referral center. Patients: The study comprised 1976 patients in a prospectively maintained institutional database who underwent pancreaticoduodenectomy or total pancreatectomy between 1998 and 2009. Main Outcome Measures: The 30- and 90-day mortality. Results: In the training cohort, age, male sex, preoperative serum albumin level, tumor size, total pancreatectomy, and a high Charlson index predicted 90-day mortality (area under the curve, 0.78; 95% CI, 0.71-0.85), whereas all these factors except Charlson index also predicted 30-day mortality (0.79; 0.68-0.89). On validation, the predicted and observed risks were not significantly different for 30-day (1.4% vs 1.0%; P=.62) and 90-day (3.8% vs 3.4%; P=.87) mortality. Both scores maintained good discrimination (for 30-day mortality, area under the curve, 0.74; 95% CI, 0.54-0.95; and for 90-day mortality, 0.73; 0.62-0.84). Conclusions: The risk scores accurately predicted 30- and 90-day mortality after pancreatectomy. They may help identify and counsel high-risk patients, support and calculate net benefits of therapeutic decisions, and control for selection bias in observational studies as propensity scores.

Original languageEnglish (US)
Pages (from-to)1277-1284
Number of pages8
JournalArchives of Surgery
Volume146
Issue number11
DOIs
StatePublished - Nov 2011

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Pancreaticoduodenectomy
Pancreatectomy
Mortality
Area Under Curve
Databases
Propensity Score
Selection Bias
Tertiary Care Centers
Serum Albumin
ROC Curve
Calibration
Observational Studies
Logistic Models
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

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Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy : A novel scoring system. / Venkat, Raghunandan; Puhan, Milo A.; Schulick, Richard D.; Cameron, John L; Eckhauser, Frederic; Choti, Michael A.; Makary, Martin A; Pawlik, Timothy M.; Ahuja, Nita; Edil, Barish H.; Wolfgang, Christopher.

In: Archives of Surgery, Vol. 146, No. 11, 11.2011, p. 1277-1284.

Research output: Contribution to journalArticle

Venkat, Raghunandan ; Puhan, Milo A. ; Schulick, Richard D. ; Cameron, John L ; Eckhauser, Frederic ; Choti, Michael A. ; Makary, Martin A ; Pawlik, Timothy M. ; Ahuja, Nita ; Edil, Barish H. ; Wolfgang, Christopher. / Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy : A novel scoring system. In: Archives of Surgery. 2011 ; Vol. 146, No. 11. pp. 1277-1284.
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abstract = "Objective: To develop and validate a risk score to predict the 30- and 90-day mortality after a pancreaticoduodenectomy or total pancreatectomy on the basis of preoperative risk factors in a high-volume program. Design: Datafroma prospectively maintained institutional database were collected. In a random subset of 70{\%} of patients (training cohort), multivariate logistic regression was used to develop a simple integer score, which was then validated in the remaining 30{\%} of patients (validation cohort). Discrimination and calibration of the score were evaluated using area under the receiver operating characteristic curve and Hosmer-Lemeshow test, respectively. Setting: Tertiary referral center. Patients: The study comprised 1976 patients in a prospectively maintained institutional database who underwent pancreaticoduodenectomy or total pancreatectomy between 1998 and 2009. Main Outcome Measures: The 30- and 90-day mortality. Results: In the training cohort, age, male sex, preoperative serum albumin level, tumor size, total pancreatectomy, and a high Charlson index predicted 90-day mortality (area under the curve, 0.78; 95{\%} CI, 0.71-0.85), whereas all these factors except Charlson index also predicted 30-day mortality (0.79; 0.68-0.89). On validation, the predicted and observed risks were not significantly different for 30-day (1.4{\%} vs 1.0{\%}; P=.62) and 90-day (3.8{\%} vs 3.4{\%}; P=.87) mortality. Both scores maintained good discrimination (for 30-day mortality, area under the curve, 0.74; 95{\%} CI, 0.54-0.95; and for 90-day mortality, 0.73; 0.62-0.84). Conclusions: The risk scores accurately predicted 30- and 90-day mortality after pancreatectomy. They may help identify and counsel high-risk patients, support and calculate net benefits of therapeutic decisions, and control for selection bias in observational studies as propensity scores.",
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AU - Schulick, Richard D.

AU - Cameron, John L

AU - Eckhauser, Frederic

AU - Choti, Michael A.

AU - Makary, Martin A

AU - Pawlik, Timothy M.

AU - Ahuja, Nita

AU - Edil, Barish H.

AU - Wolfgang, Christopher

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