title: Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP Surgical Risk Calculator.
abstract: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator was developed to help counsel patients regarding estimated postoperative risk for a variety of surgical complications. This retrospective single institutional study examined the calculator's ability to accurately predict complications and length of hospital stay (LOS) in patients who had undergone a Pancreaticoduodenectomy (PD) at our institution.
  
  
  
  165 patients at Washington University School of Medicine who underwent a PD from 8/2011 to 7/2013 were included. Surgical complication risk as determined by the ACS-NSQIP Surgical Risk Calculator were compared to actual 30 day complications. PD complications not accounted for by the calculator were compared to those without PD-specific complications.
  
  
  
  Overall predicted LOS was significantly shorter than actual duration of hospitalization (median 8.5 vs. 8.0 days; p < 0.001). 38% patients (n = 62) with Whipple-specific complication demonstrated a significant increase in LOS (8.0 vs. 12.2 days; p < 0.0001).
  
  
  
  A large proportion of complications experienced after PD are pancreas-specific, accounting for the difference in predicted vs. actual LOS and providing rationale for future development of PD specific risk models.
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63119, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Cusworth
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63119, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Krasnick
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63119, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Nywening
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63119, USA.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Woolsey
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63119, USA; Alvin J. Siteman Cancer Center, 4921 Parkview Place, St. Louis, MO 63110, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63119, USA.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Doyle
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63119, USA.
authors.forename: Jingxia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63119, USA; Alvin J. Siteman Cancer Center, 4921 Parkview Place, St. Louis, MO 63110, USA. Electronic address: hawkinsw@wudosis.wustl.edu.
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008923:Missouri; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome