New score for prediction of morbidity in patients undergoing open pancreaticoduodenectomy

Abstract

Objective The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is commonly used to predict the risk of postoperative complications in general surgery. However, use of the POSSUM is not absolutely suitable for open pancreaticoduodenectomy (OPD), which has unique complications such as pancreatic fistula formation. This study was performed to establish a new risk score for assessing the incidence of postoperative complications of OPD. Methods This retrospective case-control study involved 159 patients who underwent standard OPD from 2 January 2017 to 1 February 2019. The risk factors for post-OPD complications were statistically investigated, and a risk score model was established by multivariate logistic regression. Results Among all 159 patients, 72 (42.28%) developed complications. A scoring system was developed based on the following five independent variables: sodium concentration of <141.20 mmol/L, white blood cell count of >6.35 × 109/L, pancreatic texture grade, body mass index of >25.06 kg/m2, and basic respiratory diseases. Our risk score model demonstrated better discriminating power, prediction power, and prediction probability than the POSSUM model in the receiver operating characteristic curve analysis. Conclusion This novel risk score may help to predict postoperative complications after OPD with higher accuracy than the POSSUM system.

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

“…Severe complications occurred more often in the development cohort, namely 33%. In our study the severe complication rate was 28.9%, which is lower than other studies [ 1 , 23 ]. Assessment of the model’s performance parameters resulted in a C-index of 0.67, a regression slope of 0.37, an intercept of 0.13, a Brier score of 0.25, and a scaled Brier score of <0.001.…”

“…Likewise, no clear classification was provided in terms of severe complications and their definitions. The risk model for complications established by Chen L et al also involves pancreatic texture as an intra-operative variable, and it is graded subjectively during the operation [ 1 ]. Clavien–Dindo of II or higher was considered significant, whereas most studies reported in the literature use alternative cut-offs (IIIa, IIIb, or higher) [ 2 , 4 , 8 , 23 , 28 ].…”

“…Pancreatoduodenectomy (PD) is the operative management for patients with pancreatic head cancer and malignant or premalignant periampullary pathologies [ 1 , 2 ]. The mortality rates following this surgery have decreased over time to less than 5% [ 2 , 3 , 4 , 5 ].…”

“…The indications for this operation have been expanded to incorporate benign pathologies which may reflect on the increase of survival rates as well [ 5 ]. Despite the reduction in mortality rates, the overall complication rates remain relatively high, ranging from 40–60%, with up to 30% with severe complications [ 1 , 4 , 5 , 7 , 8 ].…”

“…Most researchers focused with their risk calculators on survival or POPF [ 20 , 21 , 22 ]. Nevertheless, there are in general very limited risk calculators for severe complications [ 1 ]. For the individual patient the risk of severe complications (Clavien–Dindo classification IIIa or more) outweighs the risk of POPF only.…”