Postpancreatectomy hemorrhage-A new classification is needed

The 2007 International Study Group of Pancreatic Surgery consensus definition for postpancreatectomy hemorrhage has become the global standard for reporting this event. However, it may no longer accurately reflect outcomes and has been found difficult to use in clinical practice.The goal of the present study is to critically evaluate the variables involved in the 2007 classification system. In addition, we aim to use these data to develop a proposal for an updated International Study Group of Pancreatic Surgery definition.

A retrospective analysis of a prospectively maintained database was conducted. Hemorrhage events were analyzed based on the 2007 International Study Group of Pancreatic Surgery parameters (timing, location, and severity) and correlated with surgical outcomes. A new classification based on clinical consequences was developed, consisting of grade A (postpancreatectomy hemorrhage with no consequences), grade B (postpancreatectomy hemorrhage with clinical intervention required), and grade C (life-threatening postpancreatectomy hemorrhage) categories. An exploratory internal validation was performed to assess the correlation of the new proposed classification system with surgical outcomes.

A total of 763 pancreatic resections were included. Analysis of 2007 International Study Group of Pancreatic Surgery variables showed no statistically significant differences in outcomes between early versus late onset or intraluminal versus extraluminal location. Notably, hemorrhages classified as "mild" (2007 International Study Group of Pancreatic Surgery criteria) exhibited high major morbidity (71.7%) and mortality (5.7%). On exploratory internal validation, the proposed new classification showed a significant increase in median hospital stay, major morbidity and mortality rates from proposed grade B to grade C, demonstrating an excellent correlation with surgical outcomes.

The individual variables of the 2007 International Study Group of Pancreatic Surgery postpancreatectomy hemorrhage classification-timing, location, and severity-no longer accurately correlate with surgical outcomes. The proposed consequence-based classification provides a simplified and accurate prognostic tool for grading postpancreatectomy hemorrhage events.