Skip to main content

Advertisement

SpringerLink
Log in

National Complication Rates after Pancreatectomy: Beyond Mere Mortality

  • 2008 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

National studies on in-hospital pancreatic outcomes have focused on mortality. Non-fatal morbidity affects a greater proportion of patients.

Methods

The Nationwide Inpatient Sample 1998–2006 was queried for discharges after pancreatectomy. Rates of major complications (myocardial infarction, aspiration pneumonia, pulmonary compromise, perforation, infection, deep vein thrombosis/pulmonary embolism, hemorrhage, or reopening of laparotomy) were assessed. Predictors of complication(s) were evaluated using logistic regression. Their independent effect on in-hospital mortality, length of stay, and discharge disposition was assessed.

Results

Of 102,417 patient discharges, 22.7% experienced a complication. Complication rates did not decline significantly over time, while mortality rates did. Independent predictors of complications included age ≥75 [referent, 19–39; adjusted odds ratio (OR) 1.34, 95% confidence interval (CI) 1.2–1.5, p < 0.0001], total pancreatectomy (vs proximal, OR 1.29, 95%CI 1.1–1.5, p = 0.0025), and low hospital resection volume (vs high, OR 1.61, 95%CI 1.4–1.8, p < 0.0001). Complications were a significant independent predictor of death (OR 7.76, 95%CI 6.7–8.8, p < 0.0001), prolonged hospital stay (OR 6.94, 95%CI 6.2–7.7, p < 0.0001), and discharge to another facility (OR 0.28, 95%CI 0.26–0.3, p < 0.0001).

Conclusions

Despite improvements in mortality, complication rates remain substantial and largely unchanged. They predict in-hospital mortality, prolonged hospital stay, and delayed return to home. The impact on healthcare costs and quality of life deserves further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248–257. doi:10.1097/00000658-199709000-00004.

    Article  PubMed  CAS  Google Scholar 

  2. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 1990;211:447–458. doi:10.1097/00000658-199004000-00011.

    Article  PubMed  CAS  Google Scholar 

  3. McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246–253. doi:10.1097/01.sla.0000259993.17350.3a.

    Article  PubMed  Google Scholar 

  4. Sohn TA, Yeo CJ, Cameron JL, Geschwind JF, Mitchell SE, Venbrux AC, Lillemoe KD. Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 2003;7:209–219. doi:10.1016/S1091-255X(02)00193-2.

    Article  PubMed  Google Scholar 

  5. Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg 2004;8:951–959. doi:10.1016/j.gassur.2004.09.044.

    Article  PubMed  Google Scholar 

  6. Tseng JF, Pisters PW, Lee JE, Wang H, Gomez HF, Sun CC, Evans DB. The learning curve in pancreatic surgery. Surgery 2007;141:456–463. doi:10.1016/j.surg.2006.09.013.

    Article  PubMed  Google Scholar 

  7. NCHS. International classification of diseases, 9th revision, clinical modification. Salt Lake City: Medicode, 2001.

    Google Scholar 

  8. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383. doi:10.1016/0021-9681(87)90171-8.

    Article  PubMed  CAS  Google Scholar 

  9. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619. doi:10.1016/0895-4356(92)90133-8.

    Article  PubMed  CAS  Google Scholar 

  10. Lawthers AG, McCarthy EP, Davis RB, Peterson LE, Palmer RH, Iezzoni LI. Identification of in-hospital complications from claims data. Is it valid? Med Care 2000;38:785–795. doi:10.1097/00005650-200008000-00003.

    Article  PubMed  CAS  Google Scholar 

  11. Crist DW, Sitzmann JV, Cameron JL. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg 1987;206:358–365. doi:10.1097/00000658-198709000-00014.

    Article  PubMed  CAS  Google Scholar 

  12. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 2006;10:1199–1210. doi:10.1016/j.gassur.2006.08.018.

    Article  PubMed  Google Scholar 

  13. Janes RH Jr, Niederhuber JE, Chmiel JS, Winchester DP, Ocwieja KC, Karnell JH, Clive RE, Menck HR. National patterns of care for pancreatic cancer. Results of a survey by the Commission on Cancer. Ann Surg 1996;223:261–272. doi:10.1097/00000658-199603000-00006.

    Article  PubMed  Google Scholar 

  14. Behrman SW, Rush BT, Dilawari RA. A modern analysis of morbidity after pancreatic resection. Am Surg 2004;70:675–682.

    PubMed  Google Scholar 

  15. Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, Riall TS, Yeo CJ. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 2006;10:347–356. doi:10.1016/j.gassur.2005.12.014.

    Article  PubMed  Google Scholar 

  16. Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, Campbell KA, Choti MA. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000;232:419–429. doi:10.1097/00000658-200009000-00014.

    Article  PubMed  CAS  Google Scholar 

  17. Sohn TA, Yeo CJ, Cameron JL, Pitt HA, Lillemoe KD. Do preoperative biliary stents increase postpancreaticoduodenectomy complications? J Gastrointest Surg 2000;4:258–267. doi:10.1016/S1091-255X(00)80074-8.

    Article  PubMed  CAS  Google Scholar 

  18. Silber JH, Rosenbaum PR, Trudeau ME, Chen W, Zhang X, Kelz RR, Mosher RE, Even-Shoshan O. Changes in prognosis after the first postoperative complication. Med Care 2005;43:122–131. doi:10.1097/00005650-200502000-00005.

    Article  PubMed  Google Scholar 

  19. Emick DM, Riall TS, Cameron JL, Winter JM, Lillemoe KD, Coleman J, Sauter PK, Yeo CJ. Hospital readmission after pancreaticoduodenectomy. J Gastrointest Surg 2006;10:1243–1252. doi:10.1016/j.gassur.2006.08.016.

    Article  PubMed  Google Scholar 

  20. Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Med Care 1992;30:615–629. doi:10.1097/00005650-199207000-00004.

    Article  PubMed  CAS  Google Scholar 

  21. Horwitz LI, Cuny JF, Cerese J, Krumholz HM. Failure to rescue: validation of an algorithm using administrative data. Med Care 2007;45:283–287. doi:10.1097/01.mlr.0000250226.33094.d4.

    Article  PubMed  Google Scholar 

  22. Riall TS, Reddy DM, Nealon WH, Goodwin JS. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 2008;248:459–467.

    PubMed  Google Scholar 

  23. Finlayson E, Fan Z, Birkmeyer JD. Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 2007;205:729–734. doi:10.1016/j.jamcollsurg.2007.06.307.

    Article  PubMed  Google Scholar 

  24. Balcom JHT, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 2001;136:391–398. doi:10.1001/archsurg.136.4.391.

    Article  PubMed  Google Scholar 

  25. Donat SM. Standards for surgical complication reporting in urologic oncology: time for a change. Urology 2007;69:221–225. doi:10.1016/j.urology.2006.09.056.

    Article  PubMed  Google Scholar 

  26. Romano PS, Schembri ME, Rainwater JA. Can administrative data be used to ascertain clinically significant postoperative complications? Am J Med Qual 2002;17:145–154. doi:10.1177/106286060201700404.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The contributions of Dr Fred Anderson in database provision and statistical analysis are greatly appreciated. Dr Simons is funded by the Pancreatic Cancer Alliance. Dr Tseng is funded by a Howard Hughes Medical Institute Early Career Award and the American Surgical Association Foundation.

Author information

Authors and Affiliations

  1. Department of Surgery, UMass Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, Suite S3-752, Worcester, MA, 01655, USA

    Jessica P. Simons, Shimul A. Shah, Sing Chau Ng, Giles F. Whalen & Jennifer F. Tseng

Authors
  1. Jessica P. Simons
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shimul A. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sing Chau Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giles F. Whalen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer F. Tseng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer F. Tseng.

Appendix

Appendix

Codes Used to Identify Postoperative Complications

Diagnosis

ICD-9-CM codes

Postoperative infection

008.45, 320.00-.99, 510.0, 510.9, 513.1, 519.2, 590.10-590.11, 590.80, 683

Myocardial infarction

410.00-410.91

Aspiration pneumonia

507.0

Deep venous thrombosis/pulmonary embolism

415.1, 451.11, 451.19, 451.2, 451.81, 453.8

Pulmonary compromise

514, 518.4, 518.5, 518.81, 518.82

Gastrointestinal hemorrhage

530.82, 531.00-.21, 531.40-.41, 531.60-.61, 532.00-.21, 532.40-.41, 532.60-.61, 533.00-.21, 533.40-41, 533.60-.61, 534.00-.21, 534.40-.41, 534.60-.61, 535.01, 535.11, 535.21, 535.31, 535.41, 535.51, 535.61, 578.9

Reopening of laparotomy

01.23, 03.02, 06.02, 34.03, 35.95, 39.49, 54.12, 54.61

Procedure-related perforation or laceration

530.4, 569.83, 575.4, 29.51, 31.61, 33.41, 33.43, 42.82, 44.61, 46.71, 46.75, 48.71, 50.61, 51.91, 55.81, 56.82, 57.81, 58.41, 69.41

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simons, J.P., Shah, S.A., Ng, S.C. et al. National Complication Rates after Pancreatectomy: Beyond Mere Mortality. J Gastrointest Surg 13, 1798–1805 (2009). https://doi.org/10.1007/s11605-009-0936-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-009-0936-1

Keywords

Search

Navigation