Quantifying the Burden of Complications Following Total Pancreatectomy Using the Postoperative Morbidity Index: A Multi-Institutional Perspective

Jashodeep Datta, Russell S. Lewis, Steven M. Strasberg, Bruce L. Hall, John D. Allendorf, Joal D. Beane, Stephen W. Behrman, Mark P. Callery, John D. Christein, Jeffrey A. Drebin, Irene Epelboym, Jin He, Henry A. Pitt, Emily Winslow, Christopher Wolfgang, Major K. Lee, Charles M. Vollmer

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: While contemporary studies demonstrate decreasing complication rates following total pancreatectomy (TP), none have quantified the impact of post-TP complications. The Postoperative Morbidity Index (PMI)—a quantitative measure of postoperative morbidity—combines ACS-NSQIP complication data with severity weighting derived from Modified Accordion Grading System. We establish the PMI for TP in a multi-institutional cohort.

Methods: Nine institutions contributed ACS-NSQIP data for 64 TPs (2005–2011). Each complication was assigned an Accordion severity weight ranging from 0.110 (grade 1/mild) to 1.00 (grade 6/death). PMI equals the sum of complication severity weights (“Total Burden”) divided by total number of patients.

Results: Overall, 29 patients (45.3 %) suffered 55 ACS-NSQIP complications; 15 (23.4 %) had >1 complication. Thirteen patients (20.3 %) were readmitted and one death (1.6 %) occurred within 30 days. Non-risk adjusted PMI was 0.151, while PMI for complication-bearing cases rose to 0.333. Bleeding/Transfusion and Sepsis were the most common complications. Discordance between frequency and burden of complications was observed. While grades 4–6 comprised only 18.5 % of complications, they contributed 37.1 % to the series’ total burden.

Conclusion: This multi-institutional series is the first to quantify the complication burden following TP using the rigor of ACS-NSQIP. A PMI of 0.151 indicates that, collectively, patients undergoing TP have an average burden of complications in the mild to moderate severity range, although complication-bearing patients have a considerable reduction in health utility.

Original languageEnglish (US)
Pages (from-to)506-515
Number of pages10
JournalJournal of Gastrointestinal Surgery
Issue number3
StatePublished - Mar 2015


  • Modified accordion system
  • Postoperative complications
  • Postoperative morbidity index
  • Severity weighting
  • Total pancreatectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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