title: International Study Group of Pancreatic Surgery Definitions for Postpancreatectomy Complications: Applicability at a High-Volume Center.
abstract: BACKGROUND
  The perioperative morbidity following pancreas surgery remains high due to various specific complications: postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. The International Study Group of Pancreatic Surgery has defined these complications. The aim of this study is to evaluate the clinical applicability, to validate the International Study Group of Pancreatic Surgery definition, and to evaluate the postoperative morbidity.
  
  
  METHODS
  Between 2004 and 2014, 769 patients underwent resection. Data were collected in a prospective database. Univariate examination was performed using the χ2-test. Continuous data were tested with the Mann-Whitney U-test. Student's t-tests and Fisher's exact tests were performed.
  
  
  RESULTS
  A total of 542 patients were included in this study. In all, 91 (16.8%) patients developed postoperative pancreatic fistula, 69 of them clinically relevant grades B and C postoperative pancreatic fistula. Grades B and C postoperative pancreatic fistulas were significantly associated with a longer hospital stay. The postoperative pancreatic fistula grade significantly correlated with re-operation. Totally, 32 (5.9%) patients developed postpancreatectomy hemorrhage. Postpancreatectomy hemorrhage grade was significantly associated with re-operation and 30-day mortality. In all, 14 of 19 patients with grade C postpancreatectomy hemorrhage (73.7%) were re-operated; 3 had a simultaneous postoperative pancreatic fistula C. Grade B postpancreatectomy hemorrhage significantly prolonged hospital stay. Grade C postpancreatectomy hemorrhage significantly prolonged intensive care unit stay. Grade C postpancreatectomy hemorrhage led to longer intensive care unit stay but a shorter hospital stay. Delayed gastric emptying occurred in 131 (24.2%) patients. The delayed gastric emptying grade was significantly associated with re-operation. Nine of the re-operated patients had a simultaneous postoperative pancreatic fistula C. Grades A, B, and C delayed gastric emptying were associated with prolonged hospital- and intensive care unit stay.
  
  
  CONCLUSIONS
  Delayed gastric emptying is the most common specific complication after pancreas resection, followed by postoperative pancreatic fistula and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery definitions are well applicable in clinical routine and the different grades correlate well with severity of clinical condition, length of hospital or intensive care unit stay, and mortality. Their widespread use can contribute to a more reproducible and reliable comparison of surgical outcomes in pancreas surgery.
authors.affiliation: 1 Department of Surgery, University Medical Centre Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Dusch
authors.affiliation: 1 Department of Surgery, University Medical Centre Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Lietzmann
authors.affiliation: 1 Department of Surgery, University Medical Centre Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Barthels
authors.affiliation: 2 Department of Surgery, Alfried Krupp Hospital, Essen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Niedergethmann
authors.affiliation: 1 Department of Surgery, University Medical Centre Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Rückert
authors.affiliation: 1 Department of Surgery, University Medical Centre Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: T J
authors.initials: TJ
authors.lastname: Wilhelm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D018589:Gastroparesis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000401:mortality; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies
keywords: International Study Group of Pancreatic Surgery; Pancreatic surgery; delayed gastric emptying; pancreas; postoperative pancreatic fistula; postpancreatectomy complications; postpancreatectomy hemorrhage