Abstract
Background
The rate of adverse events after pancreatectomy is widely reported as a measure of surgical quality. However, morbidity data are routinely acquired retrospectively and often are reported at 30 days. The authors hypothesized that morbidity after pancreatectomy is therefore underreported. They sought to compare rates of adverse events calculated at multiple time points after pancreatectomy.
Methods
The authors instituted an active surveillance system to detect, categorize, and grade the severity of all adverse events after pancreatectomy, using the modified Accordion system and International Study Group of Pancreatic Surgery definitions. All patients and clinical events were monitored directly for at least 90 days after surgery.
Results
Of 315 consecutively monitored patients, 239 (76 %) experienced 500 unique adverse events. The absolute number of unique adverse events increased by 32 % between index discharge and 90 days and by 10 % between 30 and 90 days. The number of severe adverse events increased by 96 % between discharge and 90 days and by 29 % between 30 and 90 days. In this study, 16 % of the patients experienced at least one severe adverse event within the index hospitalization, 24 % within 30 postoperative days, and 29 % within 90 days. Among the 80 readmissions that occurred within 90 days, 28 (35 %) occurred later than 30 days after pancreatectomy.
Conclusions
Approximately one-third of severe adverse events and readmissions are reported more than 30 days after surgery. All adverse events that occur within 90 days of surgery must be identified and reported for accurate characterization of the morbidity associated with pancreatectomy.
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Acknowledgment
Matthew H. G. Katz had access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study was supported by the Khalifa Bin Zayed Al Nahyan Foundation and by the Various Donor Pancreatic Research Fund at The University of Texas MD Anderson Cancer Center.
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There are no conflicts of interest.
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Lilian Schwarz and Morgan Bruno have equally contributed to this study.
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10434_2015_4437_MOESM1_ESM.tiff
Supplementary material 1 (TIFF 1521 kb). Association between the grade of the most severe AE (according to the modified ACCORDION severity grading system [ASGS]) and the number of unique AEs occurring in each patient (n = 239 patients with at least 1 AE)
10434_2015_4437_MOESM2_ESM.tiff
Supplementary material 2 (TIFF 1521 kb). Severity of pancreatic fistulas (according to the International Study Group of Pancreatic Fistula [ISGPF] grading system) reported for each patient between index discharge and 90 days after surgery (red indicates a severe pancreatic fistula (grade B or C)
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Schwarz, L., Bruno, M., Parker, N.H. et al. Active Surveillance for Adverse Events Within 90 Days: The Standard for Reporting Surgical Outcomes After Pancreatectomy. Ann Surg Oncol 22, 3522–3529 (2015). https://doi.org/10.1245/s10434-015-4437-z
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DOI: https://doi.org/10.1245/s10434-015-4437-z