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Quantifying the burden of complications following total pancreatectomy using the postoperative morbidity index: a
Jashodeep Datta1, Russell S Lewis, Steven M Strasberg
1Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA, jashodeep.datta@uphs.upenn.edu.
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.
Insights
This study quantifies complications after total pancreatectomy (TP) using the Postoperative Morbidity Index (PMI). Patients face mild to moderate burdens, but those with complications experience significant health utility reduction.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Health Services Research
Background:
- Contemporary studies show decreasing complication rates after total pancreatectomy (TP).
- However, the impact and burden of post-TP complications remain unquantified.
- The Postoperative Morbidity Index (PMI) quantifies morbidity by combining ACS-NSQIP data with Modified Accordion Grading severity weights.
Purpose of the Study:
- To establish and validate the Postoperative Morbidity Index (PMI) for total pancreatectomy (TP) in a multi-institutional cohort.
- To quantify the overall complication burden following TP.
- To analyze the relationship between complication frequency and severity.
Main Methods:
- ACS-NSQIP data from nine institutions for 64 TPs (2005-2011) were analyzed.
- Complications were assigned severity weights (0.110 to 1.00) based on the Modified Accordion Grading System.
- PMI was calculated as the sum of complication severity weights divided by the total number of patients.
Main Results:
- 29 patients (45.3%) experienced 55 complications; 15 (23.4%) had multiple complications.
- The non-risk adjusted PMI was 0.151, indicating a mild to moderate average complication burden.
- Severe complications (grades 4-6) constituted 18.5% of events but 37.1% of the total burden.
Conclusions:
- This is the first multi-institutional study to quantify the complication burden after TP using ACS-NSQIP data and the PMI.
- A PMI of 0.151 suggests an average mild to moderate complication burden for TP patients.
- Patients experiencing complications after TP have a significant reduction in health utility.
