title: Ninety-day Postoperative Mortality Is a Legitimate Measure of Hepatopancreatobiliary Surgical Quality.
abstract: OBJECTIVE
  To investigate the legitimacy of 90-day mortality as a measure of hepatopancreatobiliary quality.
  
  
  BACKGROUND
  The 90-day mortality rate has been increasingly but not universally reported after hepatopancreatobiliary surgery. The legitimacy of this definition as a measure of surgical quality has not been evaluated.
  
  
  METHODS
  We retrospectively reviewed the causes of all deaths that occurred within 365 postoperative days in patients undergoing hepatectomy (n = 2811) and/or pancreatectomy (n = 1092) from January 1997 to December 2012. The rates of surgery-related, disease-related, and overall mortality within 30 days, within 30 days or during the index hospitalization, within 90 days, and within 180 days after surgery were calculated.
  
  
  RESULTS
  Seventy-nine (3%) surgery-related deaths and 92 (3%) disease-related deaths occurred within 365 days after hepatectomy. Twenty (2%) surgery-related deaths and 112 (10%) disease-related deaths occurred within 365 days after pancreatectomy. The overall mortality rates at 99 and 118 days optimally reflected surgery-related mortality after hepatobiliary and pancreatic operations, respectively. The 90-day overall mortality rate was a less sensitive but equivalently specific measure of surgery-related death.
  
  
  CONCLUSIONS
  The 99- and 118-day definitions of postoperative mortality optimally reflected surgery-related mortality after hepatobiliary and pancreatic operations, respectively. However, among commonly reported metrics, the 90-day overall mortality rate represents a legitimate measure of surgical quality.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mise
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zimmitti
authors.forename: Nathan H
authors.initials: NH
authors.lastname: Parker
authors.forename: Claudius
authors.initials: C
authors.lastname: Conrad
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Matthew Harold G
authors.initials: MH
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006498:Hepatectomy / Q000401:mortality* / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality* / Q000592:standards; D011183:Postoperative Complications / Q000401:mortality*; D011184:Postoperative Period; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013781:Texas; D055815:Young Adult