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

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

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.

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Acknowledgments

The authors thank the ACS-NSQIP Surgical Clinical Reviewers. We also acknowledge the contributions of numerous individual surgeons from each institution represented in this study.

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Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA

    Jashodeep Datta, Russell S. Lewis Jr, Jeffrey A. Drebin, Major K. Lee IV & Charles M. Vollmer Jr.

  2. BJC Healthcare, Washington University in St. Louis School of Medicine, St Louis, MO, USA

    Steven M. Strasberg & Bruce L. Hall

  3. Olin Business School and the Center for Health Policy, Washington University in St. Louis, Saint Louis, MO, USA

    Steven M. Strasberg & Bruce L. Hall

  4. Columbia University School of Medicine, New York, NY, USA

    John D. Allendorf & Irene Epelboym

  5. Indiana University School of Medicine, Indianapolis, IN, USA

    Joal D. Beane & Henry A. Pitt

  6. University of Tennessee Health Science Center, Memphis, TN, USA

    Stephen W. Behrman

  7. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Mark P. Callery

  8. University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    John D. Christein

  9. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jin He & Christopher Wolfgang

  10. University of Wisconsin School of Medicine, Madison, WI, USA

    Emily Winslow

  11. Temple University School of Medicine, Philadelphia, PA, USA

    Henry A. Pitt

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  1. Jashodeep Datta
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  2. Russell S. Lewis Jr
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  3. Steven M. Strasberg
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  4. Bruce L. Hall
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  6. Joal D. Beane
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  7. Stephen W. Behrman
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  8. Mark P. Callery
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  9. John D. Christein
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  10. Jeffrey A. Drebin
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  11. Irene Epelboym
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  12. Jin He
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  13. Henry A. Pitt
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  14. Emily Winslow
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  15. Christopher Wolfgang
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  16. Major K. Lee IV
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  17. Charles M. Vollmer Jr.
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Correspondence to Jashodeep Datta.

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Datta, J., Lewis, R.S., Strasberg, S.M. et al. Quantifying the Burden of Complications Following Total Pancreatectomy Using the Postoperative Morbidity Index: A Multi-Institutional Perspective. J Gastrointest Surg 19, 506–515 (2015). https://doi.org/10.1007/s11605-014-2706-y

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  • DOI: https://doi.org/10.1007/s11605-014-2706-y

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