title: Prediction of Complications After Pancreaticoduodenectomy: Validation of a Postoperative Complication Score.
abstract: OBJECTIVE
  Pancreatic surgery remains associated with important morbidity. Efforts are most commonly concentrated on decreasing postoperative morbidity, but early detection of patients at risk could be another valuable strategy. A simple prognostic score has recently been published. This study aimed to validate this score and discuss possible clinical implications.
  
  
  METHODS
  From 2000 to 2012, 245 patients underwent a pancreaticoduodenectomy. Complications were graded according to the Dindo-Clavien Classification. The Braga score is based on American Society of Anesthesiologists score, pancreatic texture, Wirsung duct diameter, and blood loss. An overall risk score (0-15) can be calculated for each patient. Score discriminant power was calculated using a receiver operating characteristic curve.
  
  
  RESULTS
  Major complications occurred in 31% of patients compared with 17% in Braga's data. Pancreatic texture and blood loss were independently statistically significant for increased morbidity. Areas under the curve were 0.95 and 0.99 for 4-risk categories and for individual scores, respectively.
  
  
  CONCLUSIONS
  The Braga score discriminates well between minor and major complications. Our validation suggests that it can be used as a prognostic tool for major complications after pancreaticoduodenectomy. The clinical implications, that is, whether postoperative treatment strategies should be adapted according to the patient's individual risk, remain to be elucidated.
authors.affiliation: From the Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Gaëtan-Romain
authors.initials: GR
authors.lastname: Joliat
authors.forename: David
authors.initials: D
authors.lastname: Petermann
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors