Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP Surgical Risk Calculator

HPB (Oxford). 2017 Feb;19(2):147-153. doi: 10.1016/j.hpb.2016.10.015. Epub 2016 Dec 8.

Abstract

Background: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator was developed to help counsel patients regarding estimated postoperative risk for a variety of surgical complications. This retrospective single institutional study examined the calculator's ability to accurately predict complications and length of hospital stay (LOS) in patients who had undergone a Pancreaticoduodenectomy (PD) at our institution.

Methods: 165 patients at Washington University School of Medicine who underwent a PD from 8/2011 to 7/2013 were included. Surgical complication risk as determined by the ACS-NSQIP Surgical Risk Calculator were compared to actual 30 day complications. PD complications not accounted for by the calculator were compared to those without PD-specific complications.

Results: Overall predicted LOS was significantly shorter than actual duration of hospitalization (median 8.5 vs. 8.0 days; p < 0.001). 38% patients (n = 62) with Whipple-specific complication demonstrated a significant increase in LOS (8.0 vs. 12.2 days; p < 0.0001).

Discussion: A large proportion of complications experienced after PD are pancreas-specific, accounting for the difference in predicted vs. actual LOS and providing rationale for future development of PD specific risk models.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Decision Support Techniques*
  • Female
  • Humans
  • Length of Stay*
  • Male
  • Middle Aged
  • Missouri
  • Pancreaticoduodenectomy / adverse effects*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Postoperative Complications / therapy
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome