• Jashodeep Datta, Russell S Lewis, Steven M Strasberg, Bruce L Hall, John D Allendorf, Joal D Beane, Stephen W Behrman, Mark P Callery, John D Christein, Jeffrey A Drebin, Irene Epelboym, Jin He, Henry A Pitt, Emily Winslow, Christopher Wolfgang, Major K Lee, and Charles M Vollmer.
• Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA, jashodeep.datta@uphs.upenn.edu.
• J. Gastrointest. Surg. 2015 Mar 1; 19 (3): 506-15.

BackgroundWhile contemporary studies demonstrate decreasing complication rates following total pancreatectomy (TP), none have quantified the impact of post-TP complications. The Postoperative Morbidity Index (PMI)-a quantitative measure of postoperative morbidity-combines ACS-NSQIP complication data with severity weighting derived from Modified Accordion Grading System. We establish the PMI for TP in a multi-institutional cohort.MethodsNine institutions contributed ACS-NSQIP data for 64 TPs (2005-2011). Each complication was assigned an Accordion severity weight ranging from 0.110 (grade 1/mild) to 1.00 (grade 6/death). PMI equals the sum of complication severity weights ("Total Burden") divided by total number of patients.ResultsOverall, 29 patients (45.3 %) suffered 55 ACS-NSQIP complications; 15 (23.4 %) had >1 complication. Thirteen patients (20.3 %) were readmitted and one death (1.6 %) occurred within 30 days. Non-risk adjusted PMI was 0.151, while PMI for complication-bearing cases rose to 0.333. Bleeding/Transfusion and Sepsis were the most common complications. Discordance between frequency and burden of complications was observed. While grades 4-6 comprised only 18.5 % of complications, they contributed 37.1 % to the series' total burden.ConclusionThis multi-institutional series is the first to quantify the complication burden following TP using the rigor of ACS-NSQIP. A PMI of 0.151 indicates that, collectively, patients undergoing TP have an average burden of complications in the mild to moderate severity range, although complication-bearing patients have a considerable reduction in health utility.

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