title: WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database.
abstract: Pancreaticoduodenectomy needs simple, validated risk models to better identify 30-day mortality. The goal of this study is to develop a simple risk score to predict 30-day mortality after pancreaticoduodenectomy.
  
  
  
  We reviewed cases of pancreaticoduodenectomy from 2005-2012 in the American College of Surgeons-National Surgical Quality Improvement Program databases. Logistic regression was used to identify preoperative risk factors for morbidity and mortality from a development cohort. Scores were created using weighted beta coefficients, and predictive accuracy was assessed on the validation cohort using receiver operator characteristic curves and measuring area under the curve.
  
  
  
  The 30-day mortality rate was 2.7% for patients who underwent pancreaticoduodenectomy (n = 14,993). We identified 8 independent risk factors. The score created from weighted beta coefficients had an area under the curve of 0.71 (95% confidence interval, 0.66-0.77) on the validation cohort. Using the score WHipple-ABACUS (hypertension With medication + History of cardiac surgery + Age >62 + 2 × Bleeding disorder + Albumin <3.5 g/dL + 2 × disseminated Cancer + 2 × Use of steroids + 2 × Systemic inflammatory response syndrome), mortality rates increase with increasing score (P < .001).
  
  
  
  While other risk scores exist for 30-day mortality after pancreaticoduodenectomy, we present a simple, validated score developed using exclusively preoperative predictors surgeons could use to identify patients at risk for this procedure.
authors.affiliation: Department of Surgery, Drexel University College of Medicine, Philadelphia, PA. Electronic address: egleeson@drexelmed.edu.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Gleeson
authors.affiliation: Department of Surgery, Drexel University College of Medicine, Philadelphia, PA.
authors.forename: Mohammad F
authors.initials: MF
authors.lastname: Shaikh
authors.affiliation: Department of Surgery, Drexel University College of Medicine, Philadelphia, PA; Nutrition Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Shewokis
authors.affiliation: Department of Surgery, Drexel University College of Medicine, Philadelphia, PA.
authors.forename: John R
authors.initials: JR
authors.lastname: Clarke
authors.affiliation: Department of Surgery, Drexel University College of Medicine, Philadelphia, PA.
authors.forename: William C
authors.initials: WC
authors.lastname: Meyers
authors.affiliation: Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.affiliation: Department of Surgery, Drexel University College of Medicine, Philadelphia, PA.
authors.forename: Wilbur B
authors.initials: WB
authors.lastname: Bowne
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome