Pancreatectomy risk calculator: an ACS-NSQIP resource.
BACKGROUND
The morbidity of pancreatoduodenectomy remains high and the mortality may be significantly increased in high-risk patients. However, a method to predict post-operative adverse outcomes based on readily available clinical data has not been available. Therefore, the objective was to create a 'Pancreatectomy Risk Calculator' using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database.


METHODS
The 2005-2008 ACS-NSQIP data on 7571 patients undergoing proximal (n = 4621), distal (n = 2552) or total pancreatectomy (n = 177) as well as enucleation (n = 221) were analysed. Pre-operative variables (n = 31) were assessed for prediction of post-operative mortality, serious morbidity and overall morbidity using a logistic regression model. Statistically significant variables were ranked and weighted to create a common set of predictors for risk models for all three outcomes.


RESULTS
Twenty pre-operative variables were statistically significant predictors of post-operative mortality (2.5%), serious morbidity (21%) or overall morbidity (32%). Ten out of 20 significant pre-operative variables were employed to produce the three mortality and morbidity risk models. The risk factors included age, gender, obesity, sepsis, functional status, American Society of Anesthesiologists (ASA) class, coronary heart disease, dyspnoea, bleeding disorder and extent of surgery.


CONCLUSIONS
The ACS-NSQIP 'Pancreatectomy Risk Calculator' employs 10 easily assessable clinical parameters to assist patients and surgeons in making an informed decision regarding the risks and benefits of undergoing pancreatic resection. A risk calculator based on this prototype will become available in the future as on online ACS-NSQIP resource.
Parikh
Purvi
P
Department of Surgery, Indiana University, Indianapolis, USA.
Shiloach
Mira
M
Cohen
Mark E
ME
Bilimoria
Karl Y
KY
Ko
Clifford Y
CY
Hall
Bruce L
BL
Pitt
Henry A
HA
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality; D018579:Patient Selection; D019984:Quality Indicators, Health Care; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States
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