Using a modification of the Clavien-Dindo system accounting for readmissions and multiple interventions: Defining quality for pancreaticoduodenectomy

Background The Clavien‐Dindo system (CD) does not change the grade assigned a complication when multiple readmissions or interventions are required to manage a complication. We apply a modification of CD accounting for readmissions and interventions to pancreaticoduodenectomy (PD). Methods PDs done...

Full description

Saved in:
Bibliographic Details
Published in:Journal of surgical oncology 2014-09, Vol.110 (4), p.400-406
Main Authors: Baker, Marshall S., Sherman, Karen L., Stocker, Susan J., Hayman, Amanda V., Bentrem, David J., Prinz, Richard A., Talamonti, Mark S.
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Female
Humans
Male
Middle Aged
pancreaticoduodenectomy
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - standards
Patient Readmission
Postoperative Complications - etiology
Postoperative Hemorrhage - etiology
quality
Severity of Illness Index
surgical complications
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background The Clavien‐Dindo system (CD) does not change the grade assigned a complication when multiple readmissions or interventions are required to manage a complication. We apply a modification of CD accounting for readmissions and interventions to pancreaticoduodenectomy (PD). Methods PDs done between 1999 and 2009 were reviewed. CD grade IIIa complications requiring more than one intervention and II and IIIa complications requiring significantly prolonged lengths of stay including all 90‐day readmissions were classified severe‐adverse‐postoperative‐outcomes (SAPO). CD IIIb, IV, and V complications were also classified SAPOs. All other complications were considered minor‐adverse‐postoperative‐outcomes (MAPO). Results Four‐hundred forty three of 490 PD patients (90.4%) had either no complication or a complication of low to moderate CD grade (I, II, IIIa). When reclassified by the new metric, 92 patient‐outcomes (19%) were upgraded from CD II or IIIa to SAPO. One‐hundred thirty nine patients (28.4%) had a SAPO. Multivariable regression identified age >75 years, pylorus preservation and operative blood loss >1,500 ml as predictors of SAPO. Age was not associated with poor outcome using the unmodified CD system. Conclusions Established systems may under‐grade the severity of some complications following PD. We define a procedure‐specific modification of CD accounting for readmissions and multiple interventions. Using this modification, advanced age, pylorus preservation, and significant blood loss are associated with poor outcome. J. Surg. Oncol. 2014; 110:400–406. © 2014 Wiley Periodicals, Inc.
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.23663