WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database

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• 作者：Elizabeth M. Gleeson ; MD ; MPH^a ; ^{egleeson@drexelmed.edu" class="auth_mail" title="E-mail the corresponding author} ; Mohammad F. Shaikh ; MD^a ; Patricia A. Shewokis ; PhD^a ; ^b ; ^c ; John R. Clarke ; MD^a ; William C. Meyers ; MD^a ; Henry A. Pitt ; MD^d ; Wilbur B. Bowne ; MD^a
• 刊名：Surgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：160
• 期：5
• 页码：1279-1287
• 全文大小：227 K

文摘

Pancreaticoduodenectomy needs simple, validated risk models to better identify 30-day mortality. The goal of this study is to develop a simple risk score to predict 30-day mortality after pancreaticoduodenectomy.

Methods

We reviewed cases of pancreaticoduodenectomy from 2005–2012 in the American College of Surgeons-National Surgical Quality Improvement Program databases. Logistic regression was used to identify preoperative risk factors for morbidity and mortality from a development cohort. Scores were created using weighted beta coefficients, and predictive accuracy was assessed on the validation cohort using receiver operator characteristic curves and measuring area under the curve.

Results

The 30-day mortality rate was 2.7% for patients who underwent pancreaticoduodenectomy (n = 14,993). We identified 8 independent risk factors. The score created from weighted beta coefficients had an area under the curve of 0.71 (95% confidence interval, 0.66–0.77) on the validation cohort. Using the score WHipple-ABACUS (hypertension With medication + History of cardiac surgery + Age >62 + 2 × Bleeding disorder + Albumin <3.5 g/dL + 2 × disseminated Cancer + 2 × Use of steroids + 2 × Systemic inflammatory response syndrome), mortality rates increase with increasing score (P < .001).

Conclusion

While other risk scores exist for 30-day mortality after pancreaticoduodenectomy, we present a simple, validated score developed using exclusively preoperative predictors surgeons could use to identify patients at risk for this procedure.