title: Defining quality for distal pancreatectomy: does the laparoscopic approach protect patients from poor quality outcomes?
abstract: BACKGROUND
  Established systems for grading postoperative complications do not change the assigned grade when multiple interventions or readmissions are required to manage a complication. Studies using these systems may misrepresent outcomes for the surgical procedures being evaluated. We define a quality outcome for distal pancreatectomy (DP) and use this metric to compare laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP).
  
  
  METHODS
  Records for patients undergoing DP between January 2006 and December 2009 were reviewed. Clavien-Dindo grade IIIb, IV, and V complications were classified as severe adverse--poor quality--postoperative outcomes (SAPOs). II and IIIa complications requiring either significantly prolonged overall lengths of stay including readmissions within 90 days or more than one invasive intervention were also classified as SAPOs.
  
  
  RESULTS
  By Clavien-Dindo system alone, 91 % of DP patients had either no complication or a low/moderate grade (I, II, IIIa) complication. Using our reclassification, however, 25 % had a SAPO. Patients undergoing LDP demonstrated a Clavien-Dindo complication profile identical to that for SDP but demonstrated significantly shorter overall lengths of stay, were less likely to require perioperative transfusion, and less likely to have a SAPO.
  
  
  CONCLUSIONS
  Established systems undergrade the severity of some complications following DP. Using a procedure-specific metric for quality, we demonstrate that LDP affords a higher quality postoperative outcome than ODP.
authors.affiliation: Department of Surgery, NorthShore University Health Center, Walgreen's Building, 2nd Floor 2650 Ridge Avenue, Evanston, IL 60201, USA. mbaker3@northshore.org
authors.forename: Marshall S
authors.initials: MS
authors.lastname: Baker
authors.forename: Karen L
authors.initials: KL
authors.lastname: Sherman
authors.forename: Susan
authors.initials: S
authors.lastname: Stocker
authors.forename: Amanda V
authors.initials: AV
authors.lastname: Hayman
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prinz
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011786:Quality Control; D016896:Treatment Outcome