Risk Stratification for Distal Pancreatectomy Utilizing Acs-Nsqip: Preoperative Factors Correlate with Morbidity
Kaitlyn J. Kelly*, Yin Wan, Robert J. Rettammel, Emily Winslow, Clifford S. Cho, Sharon M. Weber
Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
Background: Evaluation of risk factors following distal pancreatectomy (DP) has been limited by data collected from retrospective, primarily single-institution studies. Using a large, multi-institutional prospectively collected dataset, we sought to define the incidence of complications after DP, identify the preoperative and operative risk factors for the development of complications, and develop a risk score that can be utilized preoperatively. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant use file was utilized to identify patients who underwent DP from 2005 to 2008 by CPT codes. Multivariate logistic regression analysis was performed to identify variables associated with 30-day morbidity and mortality. A scoring system was developed to allow for preoperative identification of patients at risk for adverse events after DP. Results: Among 2,335 patients who underwent DP, 30-day morbidity and mortality were 28% and 1.2%, respectively. Serious complications occurred in 23%, and the most common complications included sepsis (11%), surgical site infection (11%), and pneumonia (5%). On multivariate analysis, variables associated with 30-day mortality included age (>60 yrs), neurologic disease or event, elevated BUN (>40 U/L), and high intraoperative transfusion requirement (≥ 3 units). Preoperative variables associated with serious complication included: male gender, BMI, poor functional status, current smoking, preoperative sepsis, and thrombocytosis. Operative variables associated with serious complication included high intraoperative transfusion requirement (≥ 3 units), and prolonged operation time (>360 minutes). A complication risk score consisting of 1 point for each of the preoperatively determined variables predicted the risk of serious complications (p<0.0001, Table 1).Discussion: The rate of serious complication after DP is 23%. A preoperatively-determined prognostic scoring system predicts the risk for serious complications after DP. This scoring system should be utilized when counseling patients preoperatively, obtaining informed consent, and comparing quality outcome measures between institutions.
| Complication Risk Score | Incidence of Serious Complication |
| 0 | 15% |
| 1 | 21% |
| 2 | 26% |
| 3 | 35% |
| 4 | 67% |
| 5 | 100% |
| P | <0.0001 |
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