Defining the post-operative morbidity index for distal pancreatectomy
Major K Lee1, Russell S Lewis, Steven M Strasberg
1Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Surgery, Washington University in St. Louis School of Medicine, MO, USA.
Background:
Accurate assessment of complications is critical in analysing surgical outcomes. The post-operative morbidity index (PMI), derived from the Modified Accordion Severity Grading System and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), is a quantitative measure of post-operative morbidity. This study utilizes PMI to establish the complication burden for a distal pancreatectomy (DP).
Methods:
From 2005-2011, nine centres contributed ACS-NSQIP complication data for 655 DPs. Each complication was assigned an Accordion severity weight ranging from 0.11 for grade 1 to 1.00 for grade 6 (death). The PMI is the sum of complication severity weights divided by the total number of patients.
Results:
ACS-NSQIP complications occurred in 177 patients (27.0%). The non risk-adjusted PMI for DP is 0.087. Bleeding/Transfusion and Organ Space Infection were the most common complications. Frequency and burden differed across Accordion grades. While grade 4-6 complications represented only 15.4% of complication occurrences, they accounted for 30.4% of the burden. Subgroup analysis demonstrates that the PMI did not vary based on laparoscopic versus open approach or the performance of a splenectomy.
Discussion:
This study uses two validated systems to quantitatively establish the morbidity of a DP. The PMI allows estimation of both the frequency and severity of complications and thus provides a more comprehensive assessment of risk.
Insights
The post-operative morbidity index (PMI) quantifies complications after distal pancreatectomy (DP), revealing a burden of 0.087. Higher-grade complications significantly contribute to overall morbidity, aiding risk assessment.
Area of Science:
- Surgical Outcomes Research
- Morbidity Assessment
- Health Services Research
Background:
- Accurate assessment of surgical complications is crucial for evaluating outcomes.
- The Post-Operative Morbidity Index (PMI) quantifies morbidity using the Modified Accordion Severity Grading System and ACS-NSQIP data.
- This study applies the PMI to determine the complication burden in distal pancreatectomy (DP).
Purpose of the Study:
- To quantitatively establish the complication burden of distal pancreatectomy (DP) using the Post-Operative Morbidity Index (PMI).
- To assess the frequency and severity of complications following DP.
- To provide a more comprehensive risk assessment for DP.
Main Methods:
- Data from 655 distal pancreatectomies (DPs) across nine centers (2005-2011) from the ACS-NSQIP database were analyzed.
- Complications were assigned Accordion severity weights (0.11 for grade 1 to 1.00 for grade 6).
- The PMI was calculated as the sum of complication severity weights divided by the total number of patients.
Main Results:
- Complications occurred in 27.0% of patients (177/655).
- The non-risk-adjusted PMI for DP was 0.087, with bleeding/transfusion and organ space infection being most frequent.
- Higher-grade complications (4-6) constituted 15.4% of occurrences but 30.4% of the total morbidity burden. Approach (laparoscopic vs. open) and splenectomy status did not affect PMI.
Conclusions:
- The PMI, utilizing validated systems, quantitatively establishes distal pancreatectomy morbidity.
- The PMI effectively estimates both the frequency and severity of complications.
- This quantitative approach offers a more comprehensive assessment of surgical risk in DP.
