Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system.
BACKGROUND
Improving surgical quality of care requires accurate reporting of postoperative complications.


METHODS
Accuracy of a prospective surgical complication grading database was assessed by performing a retrospective review of 204 pancreaticoduodenectomies (PDs) entered into the database from January 1, 2001, to December 31, 2003. This updated database was then used to characterize 30-day morbidity and mortality after PD.


RESULTS
On review, 13% of patients had a complication not identified in the prospective complication database, 8% of patients had a complication reclassified, and 4% of patients had a complication removed. At least 1 postoperative complication was experienced by 47% of patients. After PD, 45 different complications occurred. Postoperative mortality at 30 days was 1%, and 30-day readmission rate was 11%. The 30-day reoperation rate was 9%, and 14% of patients required a percutaneous drainage procedure. Pancreatic anastomotic leak (12%), wound infection (11%), and delayed gastric emptying (7%) were the 3 most common postoperative complications, and all were associated with an increased length of stay.


CONCLUSIONS
Our prospective surgical complication database accurately characterized outcomes after PD and facilitated information gathering and analysis. The accuracy, efficiency, and reproducibility of a prospective surgical complication database favor its widespread use in postoperative complication reporting.
Grobmyer
Stephen R
SR
Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Pieracci
Fredric M
FM
Allen
Peter J
PJ
Brennan
Murray F
MF
Jaques
David P
DP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000601:surgery