title: Predictors of Clavien 4 Complications and Mortality After Necrosectomy: Analysis of the NSQIP Database.
abstract: BACKGROUND
  Acute severe pancreatitis is one of the most common gastrointestinal reasons for admission to hospitals in the USA. Up to 20 % of these patients will progress to necrotizing pancreatitis requiring intervention. The aim of this study is to identify specific preoperative factors for the development of Clavien 4 complications and mortality in patients undergoing pancreatic necrosectomy.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use files were reviewed from 2007 to 2012 to identify patients who underwent a pancreatic necrosectomy. Postoperative complications were stratified into Clavien 4 (ICU level complications) and Clavien 5 (mortality). Univariate and multivariate analyses were performed.
  
  
  RESULTS
  A total of 1156 patients underwent a pancreatic necrosectomy from 2007 to 2012. Overall, 42 % of patients experienced a Clavien 4 complication. Mortality rate was 9.5 %. Nonindependent functional status and ASA class were highly significant (p < 0.001) in univariate analysis. Frailty and emergency surgery status (p < 0.001), as well as increased blood urea nitrogen (BUN) and alkaline phosphatase and decreased albumin (p < 0.05) demonstrated independent significance of Clavien 4 complications and mortality in multivariate analysis.
  
  
  CONCLUSIONS
  This study identified specific preoperative variables that place patients at increased risk of Clavien 4 complications and mortality after necrosectomy. Identification of high-risk patients can aid in selection of appropriate treatment strategies and allow for informed preoperative discussion regarding surgical risk.
authors: Department of Acute Care Surgery/Surgical Critical Care, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA, nkolbe1@hfhs.org.
authors: Nina
authors: N
authors: Kolbe
authors: Stephanie
authors: S
authors: Bakey
authors: Lisa
authors: L
authors: Louwers
authors: Dionne
authors: D
authors: Blyden
authors: Mathilda
authors: M
authors: Horst
authors: Anthony
authors: A
authors: Falvo
authors: Joe
authors: J
authors: Patton
authors: Ilan
authors: I
authors: Rubinfeld
mesh_terms: D000328:Adult; D003646:Debridement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology