TY - JOUR
T1 - Quantifying the Burden of Complications Following Total Pancreatectomy Using the Postoperative Morbidity Index
T2 - A Multi-Institutional Perspective
AU - Datta, Jashodeep
AU - Lewis, Russell S.
AU - Strasberg, Steven M.
AU - Hall, Bruce L.
AU - Allendorf, John D.
AU - Beane, Joal D.
AU - Behrman, Stephen W.
AU - Callery, Mark P.
AU - Christein, John D.
AU - Drebin, Jeffrey A.
AU - Epelboym, Irene
AU - He, Jin
AU - Pitt, Henry A.
AU - Winslow, Emily
AU - Wolfgang, Christopher
AU - Lee, Major K.
AU - Vollmer, Charles M.
N1 - Publisher Copyright:
© 2014, The Society for Surgery of the Alimentary Tract.
PY - 2015/3
Y1 - 2015/3
N2 - 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.
AB - 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.
KW - ACS-NSQIP
KW - Modified accordion system
KW - Postoperative complications
KW - Postoperative morbidity index
KW - Severity weighting
KW - Total pancreatectomy
UR - https://www.scopus.com/pages/publications/84925511713
U2 - 10.1007/s11605-014-2706-y
DO - 10.1007/s11605-014-2706-y
M3 - Article
C2 - 25451733
AN - SCOPUS:84925511713
SN - 1091-255X
VL - 19
SP - 506
EP - 515
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 3
ER -