Establishing a quantitative benchmark for morbidity in pancreatoduodenectomy using ACS-NSQIP, the Accordion Severity Grading System, and the Postoperative Morbidity Index
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Published on: March 12, 2019
Charles M Vollmer1, Russell S Lewis, Bruce L Hall
1*Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA †Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO ‡Olin Business School and the Center for Health Policy, Washington University in St Louis, St Louis, MO; Department of Surgery, BJC Healthcare, St Louis, MO §Department of Surgery, Columbia University School of Medicine, New York, NY ‖Department of Surgery, Indiana University School of Medicine, Indianapolis, IN ¶Department of Surgery, University of Tennessee Health Science Center, Memphis, TN **Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA ††Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL ‡‡Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD §§Department of Surgery, Temple University School of Medicine, Philadelphia, PA; and ¶¶Department of Surgery, University of Wisconsin School of Medicine, Madision, WI.
Objective:
The study aim was to quantify the burden of complications of pancreatoduodenectomy (PD).
Background:
The Postoperative Morbidity Index (PMI) is a quantitative measure of the average burden of complications of a procedure. It is based on highly validated systems--ACS-NSQIP and the Modified Accordion Severity Grading System.
Methods:
Nine centers contributed ACS-NSQIP complication data for 1589 patients undergoing PD from 2005 to 2011. Each complication was assigned a severity weight ranging from 0.11 for the least severe complication to 1.00 for postoperative death, and PMI was derived. Contribution to total burden by each complication grade was used to generate a severity profile ("spectrogram") for PD. Associations with PMI were determined by regression analysis.
Results:
ACS-NSQIP complications occurred in 528 cases (33.2%). The non-risk-adjusted PMI was 0.115 (SD = 0.023) for all centers and 0.113 (SD = 0.005) for the 7 centers that contributed at least 100 cases. Grade 2 complications were predominant in frequency, and the most common complication was postoperative bleeding/transfusion. Frequency and burden of complications differed markedly. For instance, severe complications (grades 4/5/6) accounted for only about 20% of complications but for more than 40% of the burden of complications. Organ space infection had the highest burden of any complication. The average burden in cases in which a complication actually occurred was 0.346.
Conclusions:
This study develops a quantitative non-risk-adjusted benchmark for postoperative morbidity of PD. The method quantifies the burden of types and grades of postoperative complications and should prove useful in identifying areas that require quality improvement.
Insights
This study quantifies the burden of complications following pancreatoduodenectomy (PD) using the Postoperative Morbidity Index (PMI). Severe complications, though less frequent, disproportionately contribute to the overall morbidity burden.
Area of Science:
- Surgical Outcomes Research
- Patient Safety
- Health Services Research
Background:
- The Postoperative Morbidity Index (PMI) quantifies procedural complication burden.
- PMI utilizes validated systems like ACS-NSQIP and the Modified Accordion Severity Grading System.
Purpose of the Study:
- To quantify the overall burden of complications associated with pancreatoduodenectomy (PD).
- To develop a quantitative benchmark for postoperative morbidity after PD.
Main Methods:
- ACS-NSQIP complication data from 1589 PD patients across nine centers (2005-2011) were analyzed.
- Complications were assigned severity weights (0.11-1.00), and PMI was derived.
- A severity profile ('spectrogram') was generated to visualize complication burden by grade.
Main Results:
- 33.2% of PD cases experienced complications, with a non-risk-adjusted PMI of 0.115.
- Postoperative bleeding/transfusion was most frequent; organ space infection had the highest burden.
- Severe complications (grades 4-6) comprised 20% of occurrences but over 40% of the total morbidity burden.
Conclusions:
- A quantitative, non-risk-adjusted benchmark for PD postoperative morbidity was established.
- The developed method effectively quantifies complication burden by type and grade.
- This approach can identify key areas for quality improvement in PD patient care.
