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Randomized Controlled Trial
. 2017 May;24(5):243-251.
doi: 10.1002/jhbp.438. Epub 2017 Apr 5.

Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan

Shuichi Aoki  1 , Hiroaki Miyata  2   3 , Hiroyuki Konno  3 , Mitsukazu Gotoh  2   3 , Fuyuhiko Motoi  1 , Hiraku Kumamaru  2   3 , Go Wakabayashi  3 , Yoshihiro Kakeji  2   3 , Masaki Mori  1 , Yasuyuki Seto  1   2 , Michiaki Unno  3
Affiliations
Randomized Controlled Trial

Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan

Shuichi Aoki et al. J Hepatobiliary Pancreat Sci. 2017 May.

Abstract

Background: The morbidity rate after pancreaticoduodenectomy remains high. The objectives of this retrospective cohort study were to clarify the risk factors associated with serious morbidity (Clavien-Dindo classification grades IV-V), and create complication risk calculators using the Japanese National Clinical Database.

Methods: Between 2011 and 2012, data from 17,564 patients who underwent pancreaticoduodenectomy at 1,311 institutions in Japan were recorded in this database. The morbidity rate and associated risk factors were analyzed.

Results: The overall and serious morbidity rates were 41.6% and 4.5%, respectively. A pancreatic fistula (PF) with an International Study Group of Pancreatic Fistula (ISGPF) grade C was significantly associated with serious morbidity (P < 0.001). Twenty-one variables were considered statistically significant predictors of serious complications, and 15 of them overlapped with those of a PF with ISGPF grade C. The predictors included age, sex, obesity, functional status, smoking status, the presence of a comorbidity, non-pancreatic cancer, combined vascular resection, and several abnormal laboratory results. C-indices of the risk models for serious morbidity and grade C PF were 0.708 and 0.700, respectively.

Conclusions: Preventing a PF grade C is important for decreasing the serious morbidity rate and these risk calculations contribute to adequate patient selection.

Keywords: Pancreaticoduodenectomy; Postoperative complications; Risk calculator.

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Figures

Figure 1
Figure 1
Overall postoperative complications of Clavien–Dindo grades IV–V. Among cases with a complication of grades IV–V after pancreaticoduodenectomy, a pancreatic fistula grade C and organ surgical site infection (SSI) were identified in 76.47% and 40.03% of patients, respectively. Pneumonia, central nervous system (CNS) complications, renal failure and cardiac occurrences, which were generally considered a systematic complication of gastroenterological surgery, were commonly observed in about 10–20% of patients. SIRS systemic inflammatory response syndrome, SSI surgical site infection
Figure 2
Figure 2
Validation of a risk calculator for Clavien–Dindo (C–D) grades IV–V complications and a pancreatic fistula (PF) with an International Study Group of Pancreatic Fistula (ISGPF) grade C. The C‐indices of the model for complications with C–D grades IV–V and for PF with an ISGPF grade C were 0.708 (P < 0.006; confidence interval (CI): 0.687–0.728) and 0.700 (P < 0.001; CI: 0.680–0.720), respectively, indicating good discriminatory performance of the model
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