title: Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula.
abstract: BACKGROUND
  Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency; however, determinants of perioperative outcome after LLP are not well defined. We evaluated factors contributing to morbidity after LLP.
  
  
  METHODS
  Records from patients undergoing LLP from 2000 to 2008 from nine academic medical centers were evaluated to assess risk factors for perioperative complications. Extent of pancreatic resection was determined by the length of the gross pancreatic specimen. Complications and pancreatic fistula rates were assessed, and a model was developed to identify those at risk of postoperative adverse events.
  
  
  RESULTS
  Among the 219 LLP cases, indications were cystic neoplasms in 122 (56%), solid neoplasms in 83 (38%), and chronic pancreatitis in 14 (6%). Thirty-day morbidity and mortality were 39% and 0, respectively. Major complications occurred in 11%. Pancreatic fistulae were detected in 23%, with clinically important fistulae (International Study Group on Pancreatic Fistula Definition grade B/C) seen in 10%. On multivariate analysis, only greater estimated blood loss (EBL), higher body mass index (BMI), and longer length of resected pancreas were associated with major complications. A complication risk score consisting of 1 point each for BMI >27, pancreatic specimen length >8 cm, or EBL > or =150 mL predicted an increased risk of complications and pancreatic fistulae.
  
  
  CONCLUSIONS
  The risk of major complications after LLP is 11%, with clinically important pancreatic fistulae occurring in 10%. A complication risk score incorporating BMI, extent of pancreatic resection, and EBL correlates with all end points evaluated. The complication risk score should be used when quality outcome measures are evaluated.
authors.affiliation: Section of Surgical Oncology, Department of Surgery, H4/752 Clinical Science Center, University of Wisconsin Hospital, Madison, WI, USA. webers@surgery.wisc.edu
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.forename: Nipun
authors.initials: N
authors.lastname: Merchant
authors.forename: Scott
authors.initials: S
authors.lastname: Pinchot
authors.forename: Robert
authors.initials: R
authors.lastname: Rettammel
authors.forename: Atilla
authors.initials: A
authors.lastname: Nakeeb
authors.forename: David
authors.initials: D
authors.lastname: Bentrem
authors.forename: Alex
authors.initials: A
authors.lastname: Parikh
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Mazo
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hamilton
authors.forename: William
authors.initials: W
authors.lastname: Hawkins
authors.forename: C
authors.initials: C
authors.lastname: Max Schmidt
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects*; D010181:Pancreatic Cyst / Q000150:complications / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult