Quantifying the Burden of Complications Following Total Pancreatectomy Using the Postoperative Morbidity Index: A Multi-Institutional Perspective

Published on Mar 1, 2015in Journal of Gastrointestinal Surgery2.686
· DOI :10.1007/s11605-014-2706-y
Jashodeep Datta16
Estimated H-index: 16
(UPenn: University of Pennsylvania),
Russell S. Lewis10
Estimated H-index: 10
(UPenn: University of Pennsylvania)
+ 14 AuthorsCharles M. Vollmer30
Estimated H-index: 30
(UPenn: University of Pennsylvania)
Background While contemporary studies demonstrate decreasing complication rates following total pancreatectomy (TP), none have quantified the impact of post-TP complications. The Postoperative Morbidity Index (PMI)—a quantitative measure of postoperative morbidity—combines ACS-NSQIP complication data with severity weighting derived from Modified Accordion Grading System. We establish the PMI for TP in a multi-institutional cohort.
  • References (25)
  • Citations (10)
#1Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
#2Russell S. Lewis (UPenn: University of Pennsylvania)H-Index: 10
Last. Steven M. Strasberg (UPenn: University of Pennsylvania)H-Index: 32
view all 15 authors...
Objective: The study aim was to quantify the burden of complications of pancreatoduodenectomy (PD). Background: The Postoperative Morbidity Index (PMI) is a quantitative measure of the average burden of complications of a procedure. It is based on highly validated systems—ACS-NSQIP and the Modified Accordion Severity Grading System. Methods: Nine centers contributed ACS-NSQIP complication data for 1589 patients undergoing PD from 2005 to 2011. Each complication was assigned a severity weight ran...
34 CitationsSource
#1Amanda B. Cooper (Penn State Milton S. Hershey Medical Center)H-Index: 14
#2Abhishek D. Parmar (UTMB: University of Texas Medical Branch)H-Index: 13
Last. Henry A. Pitt (TU: Temple University)H-Index: 20
view all 7 authors...
Introduction The impact of neoadjuvant therapy on postpancreatectomy complications is inadequately described.
45 CitationsSource
#1Stephen W. Behrman (UTHSC: University of Tennessee Health Science Center)H-Index: 27
#2Ben L. Zarzaur (UTHSC: University of Tennessee Health Science Center)H-Index: 31
Last. Henry A. Pitt (TU: Temple University)H-Index: 20
view all 6 authors...
Background : Routine drainage of the operative bed following elective pancreatectomy remains controversial. Data specific to distal pancreatectomy (DP) have not been examined in a multi-institutional collaborative.
30 CitationsSource
#1Major K. Lee (UPenn: University of Pennsylvania)H-Index: 15
#2Russell S. Lewis (UPenn: University of Pennsylvania)H-Index: 10
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
view all 16 authors...
Background Accurate assessment of complications is critical in analysing surgical outcomes. The post-operative morbidity index (PMI), derived from the Modified Accordion Severity Grading System and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), is a quantitative measure of post-operative morbidity. This study utilizes PMI to establish the complication burden for a distal pancreatectomy (DP).
14 CitationsSource
#1Christina W. Lee (UW: University of Wisconsin-Madison)H-Index: 3
#2Henry A. Pitt (TU: Temple University)H-Index: 20
Last. Sharon M. Weber (UW: University of Wisconsin-Madison)H-Index: 39
view all 10 authors...
Introduction Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out.
30 CitationsSource
#1Amanda B. CooperH-Index: 14
#2Abhishek D. ParmarH-Index: 13
Last. Henry A. PittH-Index: 60
view all 8 authors...
2 CitationsSource
#1Louise Barbier (University of Paris)H-Index: 14
#2Wisam Jamal (University of Paris)H-Index: 1
Last. Alain Sauvanet (University of Paris)H-Index: 68
view all 8 authors...
Abstract Background The aim was to assess the outcome of a total pancreatectomy (TP). Methods From 1993 to 2010, 56 patients underwent an elective TP for intraductal papillary mucinous neoplasia (n = 42), endocrine tumours (n = 6), adenocarcinoma (n = 5), metastases (n = 2) and chronic pancreatitis (n = 1). Morbidity and survival were analysed. Long-term survivors were assessed prospectively using quality-of-life (QoL) questionnaires. Results Five patients developed gastric venous congestion int...
39 CitationsSource
#1Abhishek D. Parmar (UTMB: University of Texas Medical Branch)H-Index: 13
#2Kristin M. Sheffield (UTMB: University of Texas Medical Branch)H-Index: 23
Last. Taylor S. Riall (UTMB: University of Texas Medical Branch)H-Index: 37
view all 7 authors...
Abstract Background The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known. Methods From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons‐National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the fact...
54 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
#1Stefano Crippa (University of Verona)H-Index: 42
#2Domenico Tamburrino (University of Verona)H-Index: 15
Last. Massimo Falconi (University of Verona)H-Index: 80
view all 8 authors...
Background Total pancreatectomy (TP) has been performed rarely in the past because of its high morbidity and mortality. Because outcomes of pancreatic surgery as well as management of pancreatic insufficiency have improved markedly, enthusiasm for TP has an increased. Methods Between 1996 and 2008, 65 patients (33 females, 32 males; median age, 63 years) underwent TP at a single, high-volume center. Indications, timing, and perioperative and long-term results were analyzed. Results Twenty-five p...
68 CitationsSource
Cited By10
#1Jennifer A. Mirrielees (UW: University of Wisconsin-Madison)H-Index: 5
#2Sharon Weber (UW: University of Wisconsin-Madison)H-Index: 1
Last. John E. Scarborough (UW: University of Wisconsin-Madison)H-Index: 29
view all 6 authors...
Abstract Background Patients undergoing pancreaticoduodenectomy are at risk for a variety of adverse postoperative events, including generic complications such as surgical site infection (SSI) and procedure-specific complications such as postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). Knowing which complications have the greatest effect on these patients can help to maximize the value of quality improvement resources. This study aims to quantify the effect of specific...
#1Lianne Scholten (UvA: University of Amsterdam)H-Index: 3
#2Anouk E.J. Latenstein (UvA: University of Amsterdam)H-Index: 3
Last. Marc G. Besselink (UvA: University of Amsterdam)H-Index: 53
view all 10 authors...
Abstract Background The threshold to perform total pancreatectomy is rather high, predominantly because of concerns for long-term consequences of brittle diabetes on patients’ quality of life. Contemporary data on postoperative outcomes, diabetes management, and long-term quality of life after total pancreatectomy from large nationwide series are, however, lacking. Methods We performed a nationwide, retrospective cohort study among adults who underwent total pancreatectomy in 17 Dutch centers (2...
1 CitationsSource
#1Alessandra Pulvirenti (University of Verona)H-Index: 7
#2Antonio Pea (University of Verona)H-Index: 14
Last. Roberto Salvia (University of Verona)H-Index: 38
view all 10 authors...
ANTECEDENTES: La pancreatectomia total es una cirugia necesaria para tratar enfermedades que afectan a la totalidad el pancreas y se caracteriza por una alta morbilidad y una disminucion de la calidad de vida (QoL) a largo plazo. Hasta la fecha, los factores de riesgo asociados a los resultados perioperatorios y a largo plazo no han sido completamente determinados. METODOS: Los datos de los pacientes que se sometieron a una pancreatectomia total desde el ano 2000 al 2015 en dos centros de alto v...
4 CitationsSource
#1Rauf Shahbazov (State University of New York Upstate Medical University)H-Index: 1
#2Bashoo Naziruddin (Baylor University)H-Index: 31
Last. Nicholas Onaca (Baylor University)H-Index: 23
view all 7 authors...
Abstract Total pancreatectomy with islet autotransplantation is a promising treatment for refractory chronic pancreatitis. We analyzed postoperative complications in 83 TPIAT patients and their impact on islet graft function. We examined patient demographics, preoperative risk factors, intraoperative variables, and 30- and 90-day postoperative morbidity and mortality. Daily insulin requirement, HbA1c, C-peptide levels, and narcotic requirements were analyzed before and after surgery. Adverse eve...
2 CitationsSource
#1Laura Maggino (UPenn: University of Pennsylvania)H-Index: 11
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
Pancreatic cancer surgery is a continuously evolving field. Despite tremendous advances in perioperative outcomes, pancreatic resection is still associated with substantial morbidity, and mortality is not nil. Institutional caseload is a well-established determinant of patient outcomes, and centralization to experienced centers is essential to the safety and oncological appropriateness of the resection. Minimally invasive approaches are increasingly applied for pancreatic resection, even in canc...
9 CitationsSource
#1Rauf Shahbazov (UVA: University of Virginia)H-Index: 7
#2Gumpei Yoshimatsu (Baylor University)H-Index: 5
Last. Marlon F. Levy (MCV: VCU Medical Center)H-Index: 24
view all 10 authors...
Abstract Background The impact of pylorus preserving procedures (PP) on total pancreatectomy with islet autotransplantation (TPIAT) has not been examined. This study aimed to investigate the clinical impact of the PP on TPIAT. Methods The Baylor Simmons Transplant Institute database was queried to identify seventy-three patients who underwent TPIAT from 2006 to 2014. All patients were investigated in postoperative complications, long-term nutritional status, and graft function. Results Patients ...
7 CitationsSource
#1Shuji Suzuki (TMU: Tokyo Medical University)H-Index: 1
#2Junnosuke MiuraH-Index: 13
Last. Masakazu YamamotoH-Index: 13
view all 6 authors...
AbstractPurpose: Total pancreatectomy (TP) for pancreatic neoplasms is associated with high morbidity and mortality rates. However, with recent advances in surgical techniques and improved postoperative management, the number of cases with clinical indications for TP is increasing. Here, we evaluated the clinical outcomes post-TP.Materials and methods: Patients (n = 41) who underwent TP between 2004 and 2011 at Tokyo Women’s Medical University were retrospectively examined. Pre- and postoperativ...
5 CitationsSource
#1M Del Chiaro (Karolinska University Hospital)H-Index: 27
#2Elena Rangelova (Karolinska University Hospital)H-Index: 12
Last. Urban Arnelo (Karolinska University Hospital)H-Index: 24
view all 4 authors...
Total pancreatectomy is associated with short- and long-term high complication rate and without evidence of oncologic advantages. Several metabolic consequences are co-related with the apancreatic state. The unstable diabetes related to the total resection of the pancreas expose the patients to short- and long-term life-threatening complications. Severe hypoglycemia is a short-term dangerous complication that can also cause patients’ death. Chronic complications of severe diabetes (cardiac and v...
12 CitationsSource
#1Jashodeep Datta (UPenn: University of Pennsylvania)H-Index: 16
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
The surgical management of pancreatic diseases is rapidly evolving, encompassing advances in evidence-driven selection of patients amenable for surgical therapy, preoperative risk stratification, refinements in the technical conduct of pancreatic operations, and quantification of postoperative morbidity. These advances have resulted in dramatic reductions in mortality following pancreatic surgery, particularly at high-volume pancreatic centers. Surgical decision making is complex, and requires a...
5 CitationsSource
#1Paramin Muangkaew (MU: Mahidol University)H-Index: 2
#2Jai Young Cho (SNU: Seoul National University)H-Index: 31
Last. Seong Uk Kwon (SNU: Seoul National University)H-Index: 9
view all 9 authors...
Background The optimal surgical strategy for treating colorectal cancer liver metastases (CRLM) in patients requiring major liver resection (MLR) is controversial, especially in rectal cancer patients.
18 CitationsSource