Ninety-day Postoperative Mortality Is a Legitimate Measure of Hepatopancreatobiliary Surgical Quality

Overview

Journal Ann Surg

Specialty General Surgery

Date 2015 Jan 16

PMID 25590497

Citations 48

Authors

Yoshihiro Mise

Jean-Nicolas Vauthey

Giuseppe Zimmitti

Nathan H Parker

Claudius Conrad

Thomas A Aloia

Jeffrey E Lee

Jason B Fleming

Matthew Harold G Katz

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the legitimacy of 90-day mortality as a measure of hepatopancreatobiliary quality.

Background: The 90-day mortality rate has been increasingly but not universally reported after hepatopancreatobiliary surgery. The legitimacy of this definition as a measure of surgical quality has not been evaluated.

Methods: We retrospectively reviewed the causes of all deaths that occurred within 365 postoperative days in patients undergoing hepatectomy (n = 2811) and/or pancreatectomy (n = 1092) from January 1997 to December 2012. The rates of surgery-related, disease-related, and overall mortality within 30 days, within 30 days or during the index hospitalization, within 90 days, and within 180 days after surgery were calculated.

Results: Seventy-nine (3%) surgery-related deaths and 92 (3%) disease-related deaths occurred within 365 days after hepatectomy. Twenty (2%) surgery-related deaths and 112 (10%) disease-related deaths occurred within 365 days after pancreatectomy. The overall mortality rates at 99 and 118 days optimally reflected surgery-related mortality after hepatobiliary and pancreatic operations, respectively. The 90-day overall mortality rate was a less sensitive but equivalently specific measure of surgery-related death.

Conclusions And Relevance: The 99- and 118-day definitions of postoperative mortality optimally reflected surgery-related mortality after hepatobiliary and pancreatic operations, respectively. However, among commonly reported metrics, the 90-day overall mortality rate represents a legitimate measure of surgical quality.

Citing Articles

Estimation of the postoperative fatality window in colorectal cancer surgery.

Rutegard M, Matthiessen P, Rutegard J, Haapamaki M, Svensson J BJS Open. 2025; 9(1.

PMID: 39851201 PMC: 11758370. DOI: 10.1093/bjsopen/zrae153.

ASA-score is associated with 90-day mortality after complicated mild traumatic brain injury - a retrospective cohort study.

Kiwanuka O, Lassaren P, Hanell A, Bostrom L, Thelin E Acta Neurochir (Wien). 2024; 166(1):363.

PMID: 39259285 PMC: 11390782. DOI: 10.1007/s00701-024-06247-z.

Assessment of intermediate-term mortality following pancreatectomy for cancer.

Janczewski L, Visenio M, Joung R, Yang A, Odell D, Danielson E J Natl Cancer Inst. 2024; 117(1):49-57.

PMID: 39212612 PMC: 11717425. DOI: 10.1093/jnci/djae215.

Adverse postoperative outcomes in elderly patients with sarcopenia.

Yang Y, Sun M, Chen W, Wu S, Zhang J BMC Geriatr. 2024; 24(1):561.

PMID: 38937671 PMC: 11212269. DOI: 10.1186/s12877-024-05066-2.

Hospital volume-outcome relationships for robot-assisted surgeries: a population-based analysis.

Walker R, Stukel T, de Mestral C, Nathens A, Breau R, Hanna W Surg Endosc. 2024; 38(8):4531-4542.

PMID: 38937312 DOI: 10.1007/s00464-024-10998-2.

References

Fong Y, Gonen M, Rubin D, Radzyner M, Brennan M . Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg. 2005; 242(4):540-4. PMC: 1402350. DOI: 10.1097/01.sla.0000184190.20289.4b. View

Perkins N, Schisterman E . The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006; 163(7):670-5. PMC: 1444894. DOI: 10.1093/aje/kwj063. View

Vauthey J, Pawlik T, Ribero D, Wu T, Zorzi D, Hoff P . Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol. 2006; 24(13):2065-72. DOI: 10.1200/JCO.2005.05.3074. View

Mullen J, Ribero D, Reddy S, Donadon M, Zorzi D, Gautam S . Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007; 204(5):854-62. DOI: 10.1016/j.jamcollsurg.2006.12.032. View

Wente M, Veit J, Bassi C, Dervenis C, Fingerhut A, Gouma D . Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007; 142(1):20-5. DOI: 10.1016/j.surg.2007.02.001. View

McPhee J, Hill J, Whalen G, Zayaruzny M, Litwin D, Sullivan M . Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007; 246(2):246-53. PMC: 1933570. DOI: 10.1097/01.sla.0000259993.17350.3a. View

Gold J, Are C, Kornprat P, Jarnagin W, Gonen M, Fong Y . Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg. 2007; 247(1):109-17. DOI: 10.1097/SLA.0b013e3181557e47. View

Hwang R, Wang H, Lara A, Gomez H, Chang T, Sieffert N . Development of an integrated biospecimen bank and multidisciplinary clinical database for pancreatic cancer. Ann Surg Oncol. 2008; 15(5):1356-66. DOI: 10.1245/s10434-008-9833-1. View

McKay A, You I, Bigam D, Lafreniere R, Sutherland F, Ghali W . Impact of surgeon training on outcomes after resective hepatic surgery. Ann Surg Oncol. 2008; 15(5):1348-55. DOI: 10.1245/s10434-008-9838-9. View

10.

Csikesz N, Simons J, Tseng J, Shah S . Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery. J Gastrointest Surg. 2008; 12(9):1534-9. DOI: 10.1007/s11605-008-0566-z. View

11.

Katz M, Wang H, Fleming J, Sun C, Hwang R, Wolff R . Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009; 16(4):836-47. PMC: 3066077. DOI: 10.1245/s10434-008-0295-2. View

12.

Bilimoria K, Bentrem D, Lillemoe K, Talamonti M, Ko C . Assessment of pancreatic cancer care in the United States based on formally developed quality indicators. J Natl Cancer Inst. 2009; 101(12):848-59. PMC: 2697207. DOI: 10.1093/jnci/djp107. View

13.

Strasberg S, Linehan D, Hawkins W . The accordion severity grading system of surgical complications. Ann Surg. 2009; 250(2):177-86. DOI: 10.1097/SLA.0b013e3181afde41. View

14.

Carroll J, Smith J, Simons J, Murphy M, Ng S, Shah S . Redefining mortality after pancreatic cancer resection. J Gastrointest Surg. 2010; 14(11):1701-8. DOI: 10.1007/s11605-010-1326-4. View

15.

Brouquet A, Abdalla E, Kopetz S, Garrett C, Overman M, Eng C . High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol. 2011; 29(8):1083-90. PMC: 3068054. DOI: 10.1200/JCO.2010.32.6132. View

16.

Rahbari N, Garden O, Padbury R, Brooke-Smith M, Crawford M, Adam R . Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011; 149(5):713-24. DOI: 10.1016/j.surg.2010.10.001. View

17.

Koch M, Garden O, Padbury R, Rahbari N, Adam R, Capussotti L . Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011; 149(5):680-8. DOI: 10.1016/j.surg.2010.12.002. View

18.

Finks J, Osborne N, Birkmeyer J . Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011; 364(22):2128-37. PMC: 3150488. DOI: 10.1056/NEJMsa1010705. View

19.

Mayo S, Shore A, Nathan H, Edil B, Hirose K, Anders R . Refining the definition of perioperative mortality following hepatectomy using death within 90 days as the standard criterion. HPB (Oxford). 2011; 13(7):473-82. PMC: 3133714. DOI: 10.1111/j.1477-2574.2011.00326.x. View

20.

Reddy S, Barbas A, Turley R, Steel J, Tsung A, Marsh J . A standard definition of major hepatectomy: resection of four or more liver segments. HPB (Oxford). 2011; 13(7):494-502. PMC: 3133716. DOI: 10.1111/j.1477-2574.2011.00330.x. View