Quantifying the Burden of Complications Following Total Pancreatectomy Using the Postoperative Morbidity Index: A Multi-Institutional Perspective

Background While contemporary studies demonstrate decreasing complication rates following total pancreatectomy (TP), none have quantified the impact of post-TP complications. The Postoperative Morbidity Index (PMI)—a quantitative measure of postoperative morbidity—combines ACS-NSQIP complication dat...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2015-03, Vol.19 (3), p.506-515
Main Authors: Datta, Jashodeep, Lewis, Russell S., Strasberg, Steven M., Hall, Bruce L., Allendorf, John D., Beane, Joal D., Behrman, Stephen W., Callery, Mark P., Christein, John D., Drebin, Jeffrey A., Epelboym, Irene, He, Jin, Pitt, Henry A., Winslow, Emily, Wolfgang, Christopher, Lee, Major K., Vollmer, Charles M.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Female
Gastroenterology
Humans
Length of Stay
Male
Medicine
Medicine & Public Health
Middle Aged
Morbidity
Original Article
Pancreatectomy - adverse effects
Pancreatic cancer
Pancreatic Diseases - complications
Pancreatic Diseases - pathology
Pancreatic Diseases - surgery
Postoperative Complications - epidemiology
Retrospective Studies
Severity of Illness Index
Surgeons
Surgery
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Summary:Background While contemporary studies demonstrate decreasing complication rates following total pancreatectomy (TP), none have quantified the impact of post-TP complications. The Postoperative Morbidity Index (PMI)—a quantitative measure of postoperative morbidity—combines ACS-NSQIP complication data with severity weighting derived from Modified Accordion Grading System. We establish the PMI for TP in a multi-institutional cohort. Methods Nine institutions contributed ACS-NSQIP data for 64 TPs (2005–2011). Each complication was assigned an Accordion severity weight ranging from 0.110 (grade 1/mild) to 1.00 (grade 6/death). PMI equals the sum of complication severity weights (“Total Burden”) divided by total number of patients. Results Overall, 29 patients (45.3 %) suffered 55 ACS-NSQIP complications; 15 (23.4 %) had >1 complication. Thirteen patients (20.3 %) were readmitted and one death (1.6 %) occurred within 30 days. Non-risk adjusted PMI was 0.151, while PMI for complication-bearing cases rose to 0.333. Bleeding/Transfusion and Sepsis were the most common complications. Discordance between frequency and burden of complications was observed. While grades 4–6 comprised only 18.5 % of complications, they contributed 37.1 % to the series’ total burden. Conclusion This multi-institutional series is the first to quantify the complication burden following TP using the rigor of ACS-NSQIP. A PMI of 0.151 indicates that, collectively, patients undergoing TP have an average burden of complications in the mild to moderate severity range, although complication-bearing patients have a considerable reduction in health utility.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-014-2706-y