Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system.

BACKGROUND: Improving surgical quality of care requires accurate reporting of postoperative complications.

STUDY DESIGN: Accuracy of a prospective surgical complication grading database was assessed by performing a retrospective review of 204 pancreaticoduodenectomies (PDs) entered into the database from January 1, 2001, to December 31, 2003. This updated database was then used to characterize 30-day morbidity and mortality after PD.

RESULTS: On review, 13% of patients had a complication not identified in the prospective complication database, 8% of patients had a complication reclassified, and 4% of patients had a complication removed. At least 1 postoperative complication was experienced by 47% of patients. After PD, 45 different complications occurred. Postoperative mortality at 30 days was 1%, and 30-day readmission rate was 11%. The 30-day reoperation rate was 9%, and 14% of patients required a percutaneous drainage procedure. Pancreatic anastomotic leak (12%), wound infection (11%), and delayed gastric emptying (7%) were the 3 most common postoperative complications, and all were associated with an increased length of stay.

CONCLUSIONS: Our prospective surgical complication database accurately characterized outcomes after PD and facilitated information gathering and analysis. The accuracy, efficiency, and reproducibility of a prospective surgical complication database favor its widespread use in postoperative complication reporting.