• F Jasmijn Smits, Maaike E Verweij, Lois A Daamen, C Henri van Werkhoven, Lucas Goense, Marc G Besselink, Bert A Bonsing, Olivier R Busch, Ronald M van Dam, van EijckCasper H JCHJDepartment of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Sebastiaan Festen, KoerkampBas GrootBGDepartment of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Erwin van der Harst, Ignace H de Hingh, Geert Kazemier, Joost M Klaase, Marion van der Kolk, Mike Liem, LuyerMisha D PMDPDepartment of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands., Mark Meerdink, MieogJ Sven DJSDDepartment of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Vincent B Nieuwenhuijs, Daphne Roos, Jennifer M Schreinemakers, Martijn W Stommel, Fennie Wit, Babs M Zonderhuis, Vincent E de Meijer, Hjalmar C van Santvoort, I Quintus Molenaar, and Dutch Pancreatic Cancer Group.
• Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht and St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
• Ann. Surg. 2022 Jan 1; 275 (1): e222-e228.

ObjectiveTo quantify the impact of individual complications on mortality, organ failure, hospital stay, and readmission after pancreatoduodenectomy.Summary Of Background DataAn initial complication may provoke a sequence of adverse events potentially leading to mortality after pancreatoduodenectomy. This study was conducted to aid prioritization of quality improvement initiatives.MethodsData from consecutive patients undergoing pancreatoduodenectomy (2014-2017) were extracted from the Dutch Pancreatic Cancer Audit. Population attributable fractions (PAF) were calculated for the association of each complication (ie, postoperative pancreatic fistula, postpancreatectomy hemorrhage, bile leakage, delayed gastric emptying, wound infection, and pneumonia) with each unfavorable outcome [ie, in-hospital mortality, organ failure, prolonged hospital stay (>75th percentile), and unplanned readmission), whereas adjusting for confounders and other complications. The PAF represents the proportion of an outcome that could be prevented if a complication would be eliminated completely.ResultsOverall, 2620 patients were analyzed. In-hospital mortality occurred in 95 patients (3.6%), organ failure in 198 patients (7.6%), and readmission in 427 patients (16.2%). Postoperative pancreatic fistula and postpancreatectomy hemorrhage had the greatest independent impact on mortality [PAF 25.7% (95% CI 13.4-37.9) and 32.8% (21.9-43.8), respectively] and organ failure [PAF 21.8% (95% CI 12.9-30.6) and 22.1% (15.0-29.1), respectively]. Delayed gastric emptying had the greatest independent impact on prolonged hospital stay [PAF 27.6% (95% CI 23.5-31.8)]. The impact of individual complications on unplanned readmission was smaller than 11%.ConclusionInterventions focusing on postoperative pancreatic fistula and postpancreatectomy hemorrhage may have the greatest impact on in-hospital mortality and organ failure. To prevent prolonged hospital stay, initiatives should in addition focus on delayed gastric emptying.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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