EVALUATION OF A COMPLICATION GRADING SYSTEM FOR PANCREATIC SURGERY

Abstract

Background: Morbidity after pancreatic resections (PR) is high but comparison between centers is difficult due to the lack of a unified grading system of the severity of complications. The aim was to test the utility and ability of one suggested system (DeOliveira et al. 2006) on a consecutive series of PR. Methods: Prospectively registered complications Jan 2005-Dec 2007 were retrospectively graded (I-II: conservative management; III: invasive intervention, with (A) or without (B) general anesthesia; IV: organ failure at ICU, V: death. Results: PR = 194 (Whipple 136, Distal 31, Total 14, Beger 11, Segment 2) of which 28 were extended resections (EPR; vein- and/or multiorgan resections). Overall complications, n = 103 (53%). The grade of complication correlated with length of stay (LOS grade 0 = 9 days; I-II = 12d; IIIA = 16d; IIIB = 19d; IV = 41d; V = 17d. Whereas there was no difference in the total number of complications between PR and EPR, EPR had more severe grades (p = 0.006). Delayed gastric emptying (DGE, n = 23, 12%) was grade I-II in 87%. Pancreatic leakage (PL, n = 22, 12%) was mainly handled by minimally invasive procedures (IIIA 68%). Bleeding occurred in 11 patients (5.6%) with a mortality (grade V) of 27%. No patients with DGE or PL died. DGE had lower grade complications compared to PL (p < 0.001) and PL had lower grades than bleeding (p = 0.02). Conclusion: The suggested system discriminates well the severity of complications according to the extent of surgery and correlates with LOS. It seems useful for morbidity comparisons between pancreatic centers.