title: Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan.
abstract: BACKGROUND
  The morbidity rate after pancreaticoduodenectomy remains high. The objectives of this retrospective cohort study were to clarify the risk factors associated with serious morbidity (Clavien-Dindo classification grades IV-V), and create complication risk calculators using the Japanese National Clinical Database.
  
  
  METHODS
  Between 2011 and 2012, data from 17,564 patients who underwent pancreaticoduodenectomy at 1,311 institutions in Japan were recorded in this database. The morbidity rate and associated risk factors were analyzed.
  
  
  RESULTS
  The overall and serious morbidity rates were 41.6% and 4.5%, respectively. A pancreatic fistula (PF) with an International Study Group of Pancreatic Fistula (ISGPF) grade C was significantly associated with serious morbidity (P < 0.001). Twenty-one variables were considered statistically significant predictors of serious complications, and 15 of them overlapped with those of a PF with ISGPF grade C. The predictors included age, sex, obesity, functional status, smoking status, the presence of a comorbidity, non-pancreatic cancer, combined vascular resection, and several abnormal laboratory results. C-indices of the risk models for serious morbidity and grade C PF were 0.708 and 0.700, respectively.
  
  
  CONCLUSIONS
  Preventing a PF grade C is important for decreasing the serious morbidity rate and these risk calculations contribute to adequate patient selection.
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Aoki
authors.affiliation: The National Clinical Database, Tokyo, Japan.|The Japanese Society of Gastroenterological Surgery (JSGS) Database Committee, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: The Japanese Society of Gastroenterological Surgery (JSGS) Database Committee, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
authors.affiliation: The National Clinical Database, Tokyo, Japan.|The Japanese Society of Gastroenterological Surgery (JSGS) Database Committee, Tokyo, Japan.
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.affiliation: The National Clinical Database, Tokyo, Japan.|The Japanese Society of Gastroenterological Surgery (JSGS) Database Committee, Tokyo, Japan.
authors.forename: Hiraku
authors.initials: H
authors.lastname: Kumamaru
authors.affiliation: The Japanese Society of Gastroenterological Surgery (JSGS) Database Committee, Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
authors.affiliation: The National Clinical Database, Tokyo, Japan.|The Japanese Society of Gastroenterological Surgery (JSGS) Database Committee, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.|The National Clinical Database, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
authors.affiliation: The Japanese Society of Gastroenterological Surgery (JSGS) Database Committee, Tokyo, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Pancreaticoduodenectomy; Postoperative complications; Risk calculator