title: Preoperative risk stratification for major complications following pancreaticoduodenectomy: Identification of high-risk patients.
abstract: BACKGROUND
  Morbidity after pancreaticoduodenectomy (PD) remains a major concern with high rates. The aim of this study was to identify preoperative risk factors and create a new risk score to predict major complications after PD.
  
  
  METHODS
  Medical records of patients undergoing PD between 1993 and 2014 were retrospectively reviewed according to survival and surgical and non-surgical complications. A split-sample cross validation was conducted in which the original cohort was randomly selected to a modelling and a validation group at a ratio of 2:1. Univariate and multivariate analysis were carried out on the modelling set to identify preoperative risk factors, which were entered into a binary logistic regression model with stepwise backward elimination to develop the risk score model. Receiver operating curve analysis was implemented to judge the model's prediction ability.
  
  
  RESULTS
  PD was performed in 405 patients. A total of 29.1% (118 patients) developed major complications. On multivariate analysis, American Society of Anaesthesiologists (ASA) score and obesity as well as the presence of cardiovascular and pulmonary comorbidities were significant predictors for major complications. A risk score was derived from the regression model and successfully tested on the validation set (area under the curve = 0.84).
  
  
  CONCLUSIONS
  The risk score showed a high accuracy to predict major complications after PD based on preoperative parameters only. This simple and quick approach allows for individualized risk assessment and may improve preoperative counselling and patient selection for perioperative treatment strategies.
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany. Electronic address: Georg.Wiltberger@medizin.uni-leipzig.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Wiltberger
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Babett
authors.initials: B
authors.lastname: Muhl
authors.affiliation: Department of General-, Visceral- and Transplant Surgery, Charité University Medical Department Berlin, Campus Virchow, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Benzing
authors.affiliation: Department of General-, Visceral- and Transplant Surgery, Charité University Medical Department Berlin, Campus Virchow, Berlin, Germany.
authors.forename: Georgi
authors.initials: G
authors.lastname: Atanasov
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Hau
authors.affiliation: Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Horn
authors.affiliation: Department of General-, Visceral- and Transplant Surgery, Charité University Medical Department Berlin, Campus Virchow, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Krenzien
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bartels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011300:Preoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Major complications; Pancreaticoduodenectomy; Predictive score; Risk assessment