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Objectives: PD remains a procedure that carries considerable morbidity even when performed at high-volume centers. Numerous studies have evaluated pre-, peri-, and post-operative risk factors to predict patients at higher risk. The aim of this study was to determine if SAS predicts perioperative morbidity and mortality.Methods: We examined 405 patients who underwent successful PD between January 2000 and July 2009 with complete data. Records were reviewed for the following intraoperative SAS variables: lowest heart rate, lowest mean arterial pressure, and blood loss. Postoperative complications were graded using the Clavien scale (Grades 0 to 5), and SAS (range 0 to 10) was determined (Guwande AA, J Am Coll Surg 2007). The Cochran-Armitage test for trend was used to determine the association between grouped scores (0-2, 3-4, 5-6, 7-8, 9-10) and each of the outcomes.Results: The average age was 64 years old (range-18, 91) and there were equal numbers of males and females (199:206). There were nine perioperative deaths (2%), 146 grade two or higher complications (26%), and 64 major complications (grades 3-5, 16%). Additionally, 39 patients developed pancreatic fistulae (9.6%). Statistical analysis determined that SAS was a significant predictor of grade 2 or higher complications (p<0.0001), major morbidity (p=0.02), and pancreatic fistula (p=0.01), but not mortality (p=0.9).Conclusions: We demonstrate that the SAS is a significant predictor of perioperative morbidity for patients undergoing PD. This score should be used to identify patients at higher and lower risk in order to prioritize use of critical care beds and hospital resources.