Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy.

Details

Serval ID
serval:BIB_0EF30EB23790
Type
Article: article from journal or magazin.
Collection
Publications
Title
Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy.
Journal
Annals of surgery
Author(s)
DeOliveira M.L., Winter J.M., Schafer M., Cunningham S.C., Cameron J.L., Yeo C.J., Clavien P.A.
ISSN
0003-4932 (Print)
ISSN-L
0003-4932
Publication state
Published
Issued date
12/2006
Peer-reviewed
Oui
Volume
244
Number
6
Pages
931-7; discussion 937-9
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
To define a simple and reproducible classification of complications following pancreaticoduodenectomy (PD) based on a therapy-oriented severity grading system.
While mortality is rare after PD, morbidity rates remain high. The lack of standardization in evaluating morbidity after PD has severely hampered meaningful comparisons over time and among centers. We adapted a novel classification of complication to stratify morbidity by severity after PD, to test whether the incidence of pancreatic fistula has changed over time, and to identify risk factors in a single North American center.
The classification was applied to a consecutive series of 633 patients undergoing PD between February 2003 and August 2005. Another series of 141 patients treated between 1987 and 1990 was also analyzed to identify changes in the incidence and severity of fistula. Univariate and multivariate analyses were performed to link respective complications with preoperative and intraoperative parameters, length of hospital stay, and long-term survival.
A total of 263 (41.5%) patients did not develop any complication, while 370 (58.5%) had at least one complication; 62 (10.0%) patients had only grade I complications (no need for specific intervention), 192 patients (30.0%) had grade II (need for drug therapy such as antibiotics), 85 patients (13.5%) had grade III (need for invasive therapy), and 19 patients (3.0%) had grade IV complications (organ dysfunction with ICU stay). Grade V (death) occurred in 12 patients (2.0%). A total of 57 patients (9.0%) developed pancreatic fistula, of which 33 (58.0%) were classified as grade II, 17 (30.0%) as grade III, 5 (9.0%) as grade IV, and 2 (3.5%) as grade V. Delayed gastric emptying was documented in 80 patients (12.7%); half of them were scored as grade II and the other half as grade III. A significant decrease in the incidence of fistula was observed between the 2 periods analyzed (14.0% vs. 9.0%, P < 0.001), mostly due to a decrease in grade II fistula. Cardiovascular disease was a risk factor for overall morbidity and complication severity, while texture of the gland and cardiovascular disease were risk factors for pancreatic fistula.
This study demonstrates the applicability and utility of a new classification in grading complications following pancreatic surgery. This novel approach may provide a standardized, objective, and reproducible assessment of pancreas surgery enabling meaningful comparison among centers and over time.
Keywords
Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Humans, Incidence, Length of Stay, Male, Middle Aged, Pancreatic Diseases/mortality, Pancreatic Diseases/surgery, Pancreatic Fistula/epidemiology, Pancreaticoduodenectomy/adverse effects, Postoperative Complications/classification, Postoperative Complications/epidemiology, Reproducibility of Results, Risk Factors, Severity of Illness Index
Pubmed
Web of science
Create date
11/12/2018 15:54
Last modification date
20/08/2019 13:35
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