title: Quantifying the burden of complications following total pancreatectomy using the postoperative morbidity index: a multi-institutional perspective.
abstract: BACKGROUND
  While contemporary studies demonstrate decreasing complication rates following total pancreatectomy (TP), none have quantified the impact of post-TP complications. The Postoperative Morbidity Index (PMI)-a quantitative measure of postoperative morbidity-combines ACS-NSQIP complication data with severity weighting derived from Modified Accordion Grading System. We establish the PMI for TP in a multi-institutional cohort.
  
  
  METHODS
  Nine institutions contributed ACS-NSQIP data for 64 TPs (2005-2011). Each complication was assigned an Accordion severity weight ranging from 0.110 (grade 1/mild) to 1.00 (grade 6/death). PMI equals the sum of complication severity weights ("Total Burden") divided by total number of patients.
  
  
  RESULTS
  Overall, 29 patients (45.3 %) suffered 55 ACS-NSQIP complications; 15 (23.4 %) had >1 complication. Thirteen patients (20.3 %) were readmitted and one death (1.6 %) occurred within 30 days. Non-risk adjusted PMI was 0.151, while PMI for complication-bearing cases rose to 0.333. Bleeding/Transfusion and Sepsis were the most common complications. Discordance between frequency and burden of complications was observed. While grades 4-6 comprised only 18.5 % of complications, they contributed 37.1 % to the series' total burden.
  
  
  CONCLUSIONS
  This multi-institutional series is the first to quantify the complication burden following TP using the rigor of ACS-NSQIP. A PMI of 0.151 indicates that, collectively, patients undergoing TP have an average burden of complications in the mild to moderate severity range, although complication-bearing patients have a considerable reduction in health utility.
authors.affiliation: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA, jashodeep.datta@uphs.upenn.edu.
authors.forename: Jashodeep
authors.initials: J
authors.lastname: Datta
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: Major K
authors.initials: MK
authors.lastname: Lee
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010180:Pancreatectomy / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index