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Updated: Apr 17, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Active Surveillance for Adverse Events Within 90 Days: The Standard for Reporting Surgical Outcomes After
Lilian Schwarz1, Morgan Bruno1, Nathan H Parker1
1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Background:
The rate of adverse events after pancreatectomy is widely reported as a measure of surgical quality. However, morbidity data are routinely acquired retrospectively and often are reported at 30 days. The authors hypothesized that morbidity after pancreatectomy is therefore underreported. They sought to compare rates of adverse events calculated at multiple time points after pancreatectomy.
Methods:
The authors instituted an active surveillance system to detect, categorize, and grade the severity of all adverse events after pancreatectomy, using the modified Accordion system and International Study Group of Pancreatic Surgery definitions. All patients and clinical events were monitored directly for at least 90 days after surgery.
Results:
Of 315 consecutively monitored patients, 239 (76 %) experienced 500 unique adverse events. The absolute number of unique adverse events increased by 32 % between index discharge and 90 days and by 10 % between 30 and 90 days. The number of severe adverse events increased by 96 % between discharge and 90 days and by 29 % between 30 and 90 days. In this study, 16 % of the patients experienced at least one severe adverse event within the index hospitalization, 24 % within 30 postoperative days, and 29 % within 90 days. Among the 80 readmissions that occurred within 90 days, 28 (35 %) occurred later than 30 days after pancreatectomy.
Conclusions:
Approximately one-third of severe adverse events and readmissions are reported more than 30 days after surgery. All adverse events that occur within 90 days of surgery must be identified and reported for accurate characterization of the morbidity associated with pancreatectomy.
Insights
Morbidity after pancreatectomy is significantly underreported when only assessed at 30 days. Active surveillance for 90 days reveals a substantial increase in adverse events and readmissions, highlighting the need for extended monitoring to accurately assess surgical quality.
Area of Science:
- Surgical Quality Assessment
- Postoperative Morbidity Monitoring
- Pancreatic Surgery Outcomes
Background:
- Pancreatectomy adverse event rates are standard surgical quality metrics.
- Current reporting often relies on retrospective data collected up to 30 days post-surgery.
- This limited timeframe may lead to underreporting of overall morbidity.
Purpose of the Study:
- To investigate the hypothesis that pancreatectomy morbidity is underreported.
- To compare adverse event rates at multiple time points after pancreatectomy.
- To determine the impact of extended surveillance on reported morbidity.
Main Methods:
- Implementation of an active surveillance system for adverse events.
- Utilizing modified Accordion system and International Study Group of Pancreatic Surgery definitions.
- Direct monitoring of patients and clinical events for at least 90 days post-surgery.
Main Results:
- 76% of 315 patients experienced 500 unique adverse events.
- Total adverse events increased by 32% between discharge and 90 days.
- Severe adverse events rose by 96% by 90 days; 35% of readmissions occurred after 30 days.
Conclusions:
- A significant portion of severe adverse events and readmissions occur beyond 30 days.
- Extended surveillance up to 90 days is crucial for accurate morbidity assessment.
- Comprehensive reporting of all 90-day postoperative events is necessary for reliable pancreatectomy quality evaluation.
