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Development of a Novel Pancreatoduodenectomy-Specific Risk Calculator: an Analysis of 10,000 Patients

Journal of Gastrointestinal Surgery volume 25, pages 1503–1511 (2021)Cite this article

Abstract

Background

Pancreatoduodenectomy (PD) is often performed in frail patients and is associated with significant morbidity. The five-factor modified frailty index (mFI-5) has been utilized to predict adverse postoperative outcomes, but has not been tested in PD. We aimed to develop risk tools to generate and predict 30-day outcomes after PD and compare their performance with the mFI-5. Risk tools were then used to generate a PD-specific calculator.

Methods

Elective PDs from the 2014–2016 ACS NSQIP® Procedure Targeted Pancreatectomy PUFs were identified. Multivariable logistic regression models were constructed to predict postoperative mortality, any complication, serious complication, clinically relevant postoperative pancreatic fistula (CR-POPF), and discharge not-to-home. Predictive accuracy was evaluated through repeated stratified tenfold cross-validation and compared to the mFI-5.

Results

Nine thousand eight hundred sixty-seven PDs were captured. Nine risk factors were retained: sex, age, BMI, DM, HTN, ASA classification, pancreatic duct size, gland texture, and adenocarcinoma. Cross-validated C-indices ranged from 0.49 to 0.61 for the mFI-5 and 0.63 to 0.75 for our risk models. The best-performing model was for discharge not-to-home (C = 0.75), and the model delivering the largest increase in predictive accuracy was for CR-POPF (CmFI-5/Model = 0.49/0.70). A user-friendly risk calculator was created predicting the five outcomes of interest.

Conclusion

We have created a PD-specific risk calculator that outperforms the mFI-5. This calculator may serve as a useful adjunct in shared decision-making for patients and surgeons.

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Author information

Affiliations

  1. Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 421, Pittsburgh, PA, 15232, USA

    Amr I. Al Abbas MD & Amer H. Zureikat MD

  2. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Amr I. Al Abbas MD & Herbert J. Zeh III MD

  3. The Wolff Center at UPMC, Pittsburgh, PA, USA

    Jeffrey D. Borrebach MS & Johanna Bellon PhD

  4. Temple University Health System, Philadelphia, PA, USA

    Henry A. Pitt MD

  5. Northshore University HealthSystem, Evanston, IL, USA

    Melissa E. Hogg MD

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  1. Amr I. Al Abbas MD
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  2. Jeffrey D. Borrebach MS
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  3. Henry A. Pitt MD
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  4. Johanna Bellon PhD
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Correspondence to Amer H. Zureikat MD.

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Electronic supplementary material

Supplemental Table 1.

Postoperative Outcomes Comprising Any Complication and Serious Complication (DOCX 32 kb)

Supplemental Application 1.

Pancreatoduodenectomy Risk Calculator (XLSX 23 kb)

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Al Abbas, A.I., Borrebach, J.D., Pitt, H.A. et al. Development of a Novel Pancreatoduodenectomy-Specific Risk Calculator: an Analysis of 10,000 Patients. J Gastrointest Surg 25, 1503–1511 (2021). https://doi.org/10.1007/s11605-020-04725-0

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Keywords

  • Pancreatoduodenectomy
  • Whipple
  • Calculator
  • Frailty
  • Pancreatic surgery