Journal of Gastrointestinal Surgery

, Volume 17, Issue 2, pp 273–280

Defining Quality for Distal Pancreatectomy: Does the Laparoscopic Approach Protect Patients from Poor Quality Outcomes?

Authors

    • Department of SurgeryNorthShore University Health Center
  • Karen L. Sherman
    • Northwestern UniversityFeinberg School of Medicine
  • Susan Stocker
    • Department of SurgeryNorthShore University Health Center
    • Northwestern UniversityFeinberg School of Medicine
  • Amanda V. Hayman
    • Northwestern UniversityFeinberg School of Medicine
  • David J. Bentrem
    • Northwestern UniversityFeinberg School of Medicine
  • Richard A. Prinz
    • Department of SurgeryNorthShore University Health Center
  • Mark S. Talamonti
    • Department of SurgeryNorthShore University Health Center
2012 SSAT Poster Presentation

DOI: 10.1007/s11605-012-2104-2

Cite this article as:
Baker, M.S., Sherman, K.L., Stocker, S. et al. J Gastrointest Surg (2013) 17: 273. doi:10.1007/s11605-012-2104-2

Abstract

Introduction

Established systems for grading postoperative complications do not change the assigned grade when multiple interventions or readmissions are required to manage a complication. Studies using these systems may misrepresent outcomes for the surgical procedures being evaluated. We define a quality outcome for distal pancreatectomy (DP) and use this metric to compare laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP).

Methods

Records for patients undergoing DP between January 2006 and December 2009 were reviewed. Clavien–Dindo grade IIIb, IV, and V complications were classified as severe adverse—poor quality—postoperative outcomes (SAPOs). II and IIIa complications requiring either significantly prolonged overall lengths of stay including readmissions within 90 days or more than one invasive intervention were also classified as SAPOs.

Results

By Clavien–Dindo system alone, 91 % of DP patients had either no complication or a low/moderate grade (I, II, IIIa) complication. Using our reclassification, however, 25 % had a SAPO. Patients undergoing LDP demonstrated a Clavien–Dindo complication profile identical to that for SDP but demonstrated significantly shorter overall lengths of stay, were less likely to require perioperative transfusion, and less likely to have a SAPO.

Conclusions

Established systems undergrade the severity of some complications following DP. Using a procedure-specific metric for quality, we demonstrate that LDP affords a higher quality postoperative outcome than ODP.

Keywords

Laparoscopic distal pancreatectomyOpen distal pancreatectomySurgical complicationsQuality

Copyright information

© The Society for Surgery of the Alimentary Tract 2012