title: Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy: a novel scoring system.
abstract: OBJECTIVE
  To develop and validate a risk score to predict the 30- and 90-day mortality after a pancreaticoduodenectomy or total pancreatectomy on the basis of preoperative risk factors in a high-volume program.
  
  
  METHODS
  Data from a prospectively maintained institutional database were collected. In a random subset of 70% of patients (training cohort), multivariate logistic regression was used to develop a simple integer score, which was then validated in the remaining 30% of patients (validation cohort). Discrimination and calibration of the score were evaluated using area under the receiver operating characteristic curve and Hosmer-Lemeshow test, respectively.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  The study comprised 1976 patients in a prospectively maintained institutional database who underwent pancreaticoduodenectomy or total pancreatectomy between 1998 and 2009.
  
  
  METHODS
  The 30- and 90-day mortality.
  
  
  RESULTS
  In the training cohort, age, male sex, preoperative serum albumin level, tumor size, total pancreatectomy, and a high Charlson index predicted 90-day mortality (area under the curve, 0.78; 95% CI, 0.71-0.85), whereas all these factors except Charlson index also predicted 30-day mortality (0.79; 0.68-0.89). On validation, the predicted and observed risks were not significantly different for 30-day (1.4% vs 1.0%; P = .62) and 90-day (3.8% vs 3.4%; P = .87) mortality. Both scores maintained good discrimination (for 30-day mortality, area under the curve, 0.74; 95% CI, 0.54-0.95; and for 90-day mortality, 0.73; 0.62-0.84).
  
  
  CONCLUSIONS
  The risk scores accurately predicted 30- and 90-day mortality after pancreatectomy. They may help identify and counsel high-risk patients, support and calculate net benefits of therapeutic decisions, and control for selection bias in observational studies as propensity scores.
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Raghunandan
authors: R
authors: Venkat
authors: Milo A
authors: MA
authors: Puhan
authors: Richard D
authors: RD
authors: Schulick
authors: John L
authors: JL
authors: Cameron
authors: Frederic E
authors: FE
authors: Eckhauser
authors: Michael A
authors: MA
authors: Choti
authors: Martin A
authors: MA
authors: Makary
authors: Timothy M
authors: TM
authors: Pawlik
authors: Nita
authors: N
authors: Ahuja
authors: Barish H
authors: BH
authors: Edil
authors: Christopher L
authors: CL
authors: Wolfgang
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D015233:Models, Statistical; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D059035:Perioperative Period; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome