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Prediction of Complications After Pancreaticoduodenectomy

Validation of a Postoperative Complication Score

Joliat, Gaëtan-Romain MD; Petermann, David MD; Demartines, Nicolas MD; Schäfer, Markus MD

doi: 10.1097/MPA.0000000000000399
Original Articles
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Objectives Pancreatic surgery remains associated with important morbidity. Efforts are most commonly concentrated on decreasing postoperative morbidity, but early detection of patients at risk could be another valuable strategy. A simple prognostic score has recently been published. This study aimed to validate this score and discuss possible clinical implications.

Methods From 2000 to 2012, 245 patients underwent a pancreaticoduodenectomy. Complications were graded according to the Dindo-Clavien Classification. The Braga score is based on American Society of Anesthesiologists score, pancreatic texture, Wirsung duct diameter, and blood loss. An overall risk score (0–15) can be calculated for each patient. Score discriminant power was calculated using a receiver operating characteristic curve.

Results Major complications occurred in 31% of patients compared with 17% in Braga's data. Pancreatic texture and blood loss were independently statistically significant for increased morbidity. Areas under the curve were 0.95 and 0.99 for 4-risk categories and for individual scores, respectively.

Conclusions The Braga score discriminates well between minor and major complications. Our validation suggests that it can be used as a prognostic tool for major complications after pancreaticoduodenectomy. The clinical implications, that is, whether postoperative treatment strategies should be adapted according to the patient's individual risk, remain to be elucidated.

From the Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.

Received for publication June 22, 2014; accepted January 28, 2015.

Reprints: Gaëtan-Romain Joliat, MD, Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland (e-mail: gaetan.joliat@gmail.com).

The authors declare no conflict of interest.

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