Match!

Assessing the impact of a fistula after a pancreaticoduodenectomy using the Post‐operative Morbidity Index

Published on Oct 1, 2013in Hpb3.047
· DOI :10.1111/hpb.12131
Benjamin C. Miller5
Estimated H-index: 5
(UPenn: University of Pennsylvania),
John D. Christein29
Estimated H-index: 29
(UAB: University of Alabama at Birmingham)
+ 6 AuthorsCharles M. Vollmer40
Estimated H-index: 40
(UPenn: University of Pennsylvania)
Abstract
Abstract Background The Post‐operative Morbidity Index (PMI) is a quantitative utility measure of a complication burden created by severity weighting. The Fistula Risk Score (FRS) is a validated model that predicts whether a patient will develop a post‐operative pancreatic fistula (POPF). These novel tools might provide further discrimination of the ISGPF grading system. Methods From 2001 to 2012, 1021 pancreaticoduodenectomies were performed at four institutions. POPFs were categorized by ISGPF standards. PMI scores were calculated based on the Modified Accordion Severity Grading System. FRS scores were assigned according to the relative influence of four recognized factors for developing a clinically relevant POPF (CR‐POPF). Results In total, 231 patients (22.6%) developed a POPF, of which 54.1% were CR‐POPFs. The PMI differed significantly between the ISGPF grades and patients with no or non‐fistulous complications ( P R 2 = 0.81, P Conclusion These data quantitatively reinforce the ISGPF grades that were developed qualitatively around the concept of clinical severity. CR‐POPFs usually reflect the patient's highest Accordion score whereas biochemical POPFs are often superseded. The correlation between FRS and PMI indicates that risk factors for a fistula contribute to overall pancreaticoduodenectomy morbidity.
  • References (18)
  • Citations (21)
📖 Papers frequently viewed together
20053.48Surgery
2,877 Citations
301 Citations
20073.48Surgery
1,083 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References18
Newest
#1Mark P. Callery (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 48
#2Wande B. Pratt (WashU: Washington University in St. Louis)H-Index: 17
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 5 authors...
Background Clinically relevant postoperative pancreatic fistulas (CR-POPF) are serious inherent risks of pancreatic resection. Preoperative CR-POPF risk assessment is currently inadequate and rarely disqualifies patients who need resection. The best evaluation of risk occurs intraoperatively, and should guide fistula prevention and response measures thereafter. We sought to develop a risk prediction tool for CR-POPF that features intraoperative assessment and reveals associated clinical and econ...
301 CitationsSource
#1Steven M. Strasberg (WashU: Washington University in St. Louis)H-Index: 32
#2Bruce L. Hall (WashU: Washington University in St. Louis)H-Index: 14
Background Postoperative complications are key outcomes of surgical procedures, but currently there is no uniform quantitative measure of complication severity. The purpose of this study was to evaluate and establish feasibility of quantitative morbidity scores for several common abdominal surgical procedures. Study Design Using American College of Surgeons' National Surgical Quality Improvement Program data, complications were identified in 5 common abdominal procedures for one institution in 2...
63 CitationsSource
#1Matthew R. Porembka (WashU: Washington University in St. Louis)H-Index: 14
#2Bruce L. Hall (WashU: Washington University in St. Louis)H-Index: 35
Last. Steven M. Strasberg (WashU: Washington University in St. Louis)H-Index: 32
view all 4 authors...
Background To quantify severity of postoperative complications based on the Accordion Severity Grading System, determine the ability of severity grading to enhance National Surgical Quality Improvement Program (NSQIP) data, and develop an aggregate measure of severity of complications (the postoperative morbidity index). Study Design Forty-three surgical experts rated case vignettes containing postoperative complications on a severity scale. Vignettes were based on the Accordion Severity Grading...
119 CitationsSource
#1Henry A. Pitt (IU: Indiana University)H-Index: 41
#2Molly E. Kilbane (IU: Indiana University)H-Index: 1
Last. Sean J. Mulvihill (UofU: University of Utah)H-Index: 42
view all 9 authors...
Abstract Background The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was started in 2004. Presently, 58% of the 198 hospitals participating in ACS-NSQIP are academic or teaching hospitals. In 2008, ACS-NSQIP initiated a number of changes and made risk-adjusted data available for use by participating hospitals. This analysis explores the ACS-NSQIP database for utility in developing hepato-pancreato-biliary (HPB) surgery-specific outcomes (HPB-NSQIP). Meth...
79 CitationsSource
#1Steven M. StrasbergH-Index: 32
#2David C. Linehan (WashU: Washington University in St. Louis)H-Index: 50
Last. William G. HawkinsH-Index: 30
view all 3 authors...
Background:A severity grading system is essential to reporting surgical complications. In 1992, we presented such a system (T92). Its use and that of systems derived from it have increased exponentially. Our purpose was to determine how well T92 and its modifications have functioned as a severity gr
333 CitationsSource
#1Mark P. Callery (Harvard University)H-Index: 48
#2Wande B. Pratt (Harvard University)H-Index: 17
Last. Charles M. Vollmer (Harvard University)H-Index: 40
view all 3 authors...
Despite significant improvements in the safety and efficacy of pancreatic surgery, post-operative pancreatic fistulae remain an unsolved dilemma. These occur when the transected pancreatic gland, pancreatic-enteric anastomosis, or both, leak rendering the patient at significant risk. They are especially important today since indications for resection (IPMN, carcinoma) continue to increase. This review considers definitions and classifications of pancreatic fistulae, risk factors, preventative ap...
78 CitationsSource
#1Wande B. Pratt (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 17
#2Mark P. Callery (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 48
Last. Charles M. Vollmer (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 40
view all 3 authors...
Background: The International Study Group on Pancreatic Fistula (ISGPF) classification scheme has become a useful system for characterizing the clinical impact of pancreatic fistula. We sought to identify predictive factors that predispose patients to fistula, specifically those with clinical relevance (grades B/C), and to describe the clinical and economic significance of risk stratification within this framework.
213 CitationsSource
#1Tingbo Liang (ZJU: Zhejiang University)H-Index: 26
#2Xueli Bai (ZJU: Zhejiang University)H-Index: 20
Last. Shusen Zheng (ZJU: Zhejiang University)H-Index: 42
view all 3 authors...
Aims: The aim of the study is to validate a new classification of pancreatic fistula (PF) and to document risk factors for PF. Methods: A retrospective study was
41 CitationsSource
#1Stephen R. Grobmyer (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 39
#2Fredric M. Pieracci (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 26
Last. David P. Jaques (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 38
view all 5 authors...
Background Improving surgical quality of care requires accurate reporting of postoperative complications. Study design Accuracy of a prospective surgical complication grading database was assessed by performing a retrospective review of 204 pancreaticoduodenectomies (PDs) entered into the database from January 1, 2001, to December 31, 2003. This updated database was then used to characterize 30-day morbidity and mortality after PD. Results On review, 13% of patients had a complication not identi...
187 CitationsSource
#1Wande B. PrattH-Index: 17
#2Shishir K. MaithelH-Index: 38
Last. Charles M. VollmerH-Index: 40
view all 6 authors...
Pancreatic fistula is widely regarded as the most ominous of complications following pancreatic resection. Its clinical impact and sequelae have been previously described and shown to contribute to the development of other morbid complications and high rates of mortality.1–4 Despite refinements in operative technique and advancements in postoperative management, fistulas still occur with a frequency of 5% to 30%.5–12 Efforts to mitigate this problem have included technical considerations (modifi...
251 CitationsSource
Cited By21
Newest
#1Jian Lin (Fujian Medical University)
#2Biqing Ni (Fujian Medical University)
Last. Guozhong Liu (Fujian Medical University)
view all 3 authors...
AbstractPurpose: This study aimed to evaluate the efficacy of percutaneous endoscopic necrosectomy (PEN) combined with percutaneous catheter drainage (PCD) and irrigation versus PCD for the treatme...
Source
Source
#1Stephan Schorn (TUM: Technische Universität München)H-Index: 9
#2Ihsan Ekin Demir (TUM: Technische Universität München)H-Index: 26
Last. Güralp O. Ceyhan (TUM: Technische Universität München)H-Index: 28
view all 8 authors...
Background Pancreaticoduodenectomy/PD is a technically demanding pancreatic resection. Options of surgical reconstruction include (1) the child reconstruction defined as pancreatojejunostomy/PJ followed by hepaticojejunostomy/HJ and the gastrojejunostomy/GJ “the standard/s-Child,” (2) the s-child reconstruction with an additional Braun enteroenterostomy “BE-Child,” or (3) Isolated-Roux-En-Y-pancreaticojejunostomy “Iso-Roux-En-Y,” in which the pancreas anastomosis is reconstructed in a separate l...
Source
#1Ayman El Nakeeb (Mansoura University)H-Index: 18
#2Mohamed El Sorogy (Mansoura University)H-Index: 5
Last. Ahmed M. Elsabbagh (Mansoura University)H-Index: 2
view all 8 authors...
Abstract Background Few studies investigated biliary leakage after pancreaticoduodenectomy (PD) especially when compared to postoperative pancreatic fistula (POPF). This study was to determine the incidence of biliary leakage after PD, predisposing factors of biliary leakage, and its management. Methods We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery Center, Mansoura University, Egypt. According to occurrence of postoperativ...
Source
#1Vandana AgarwalH-Index: 3
#2Martin Jose Thomas (Westmead Hospital)H-Index: 1
Last. Shailesh V. ShrikhandeH-Index: 30
view all 9 authors...
Background Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery.
2 CitationsSource
#1May C. Tee (Mayo Clinic)H-Index: 6
#2Adam C. Krajewski (Mayo Clinic)H-Index: 3
Last. Mark J. Truty (Mayo Clinic)H-Index: 23
view all 10 authors...
Background Pancreatectomy with arterial resection (AR) is performed infrequently. As indications evolve, we evaluated indications, outcomes, and predictors of mortality, morbidity, and survival after AR. Study Design We performed a single-institution review of elective pancreatectomies with AR (from July1990 to July 2017). Univariate and multivariate analyses were performed for predictors of outcomes and survival. Results A total of 111 patients underwent pancreatectomy with AR including any hep...
6 CitationsSource
#1Li BinH-Index: 47
#2Chang XuH-Index: 1
Last. JIANGXiaoqingH-Index: 17
view all 7 authors...
Abstract Background Postoperative pancreatic fistula (POPF) is a severe complication of the pancreaticoduodenectomy (PD). Recently, we introduced a method of suspender pancreaticojejunostomy (PJ) to the PD. In this study, we retrospectively analyzed various risk factors for complications after PD. We also introduced and assessed the suspender PJ to demonstrate its advantages. Methods Data from 335 patients with various periampullary lesions, who underwent the Whipple procedure (classic Whipple p...
Source
#1Priya M. Puri (UPenn: University of Pennsylvania)H-Index: 3
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
Postoperative pancreatic fistula (POPF) is the most common complication after major pancreatic resections and is the greatest contributor to postoperative morbidity and mortality following pancreatoduodenectomy (PD). The relatively recent establishment of a standardized definition of POPF by the International Study Group of Pancreatic Fistula (ISGPF) allowed for the delineation between innocuous biochemical POPF (grade A) and clinically relevant (CR) POPF (grades B and C). This classification sy...
Source
Last. Claudio Bassi (University of Verona)H-Index: 80
view all 6 authors...
Source
#1Claudio BassiH-Index: 80
Last. Markus W. Büchler (Heidelberg University)H-Index: 127
view all 33 authors...
Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of th...
421 CitationsSource