title: Defining the post-operative morbidity index for distal pancreatectomy.
abstract: BACKGROUND
  Accurate assessment of complications is critical in analysing surgical outcomes. The post-operative morbidity index (PMI), derived from the Modified Accordion Severity Grading System and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), is a quantitative measure of post-operative morbidity. This study utilizes PMI to establish the complication burden for a distal pancreatectomy (DP).
  
  
  METHODS
  From 2005-2011, nine centres contributed ACS-NSQIP complication data for 655 DPs. Each complication was assigned an Accordion severity weight ranging from 0.11 for grade 1 to 1.00 for grade 6 (death). The PMI is the sum of complication severity weights divided by the total number of patients.
  
  
  RESULTS
  ACS-NSQIP complications occurred in 177 patients (27.0%). The non risk-adjusted PMI for DP is 0.087. Bleeding/Transfusion and Organ Space Infection were the most common complications. Frequency and burden differed across Accordion grades. While grade 4-6 complications represented only 15.4% of complication occurrences, they accounted for 30.4% of the burden. Subgroup analysis demonstrates that the PMI did not vary based on laparoscopic versus open approach or the performance of a splenectomy.
  
  
  CONCLUSIONS
  This study uses two validated systems to quantitatively establish the morbidity of a DP. The PMI allows estimation of both the frequency and severity of complications and thus provides a more comprehensive assessment of risk.
authors.affiliation: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Surgery, Washington University in St. Louis School of Medicine, MO, USA.
authors.forename: Major K
authors.initials: MK
authors.lastname: Lee
authors.forename: Russell S
authors.initials: RS
authors.lastname: Lewis
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.forename: John D
authors.initials: JD
authors.lastname: Allendorf
authors.forename: Joal D
authors.initials: JD
authors.lastname: Beane
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Behrman
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.forename: John D
authors.initials: JD
authors.lastname: Christein
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Drebin
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.forename: Jin
authors.initials: J
authors.lastname: He
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Emily
authors.initials: E
authors.lastname: Winslow
authors.forename: Christopher
authors.initials: C
authors.lastname: Wolfgang
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013156:Splenectomy / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult