Table 1 Relevant definitions

New onset

Not present any time in 24 h before study intervention; accounts for all outcomes

Mortality

Rate of death occurring within 90 days after index pancreatic resection or, if index admission exceeds 90 days, during admission

 Pulmonary

PaO2 < 60 mmHg, despite FiO2 of 0.3, or need for mechanical ventilation

 Circulatory

Systolic blood pressure < 90 mmHg, despite adequate fluid resuscitation, or need for inotropic support

 Renal

Creatinine level > 177 μmol/liter after rehydration or need for hemofiltration or hemodialysis

Post-pancreatectomy hemorrhage (PPH)

Adapted from Wente et al [18]

 Grade A

Occurring < 24 h after pancreatectomy (early) with no therapeutic consequences

 Grade B

Both early (< 24 h) and late (> 24 h) requiring therapy (including fluid or blood transfusion and transfer to high-care unit), with non-life-threatening clinical condition. Includes early PPH requiring relaparotomy

 Grade C

Occurring > 24 h after pancreatectomy (late) with severely impaired, life-threatening clinical condition requiring intervention

Comprehensive Complication Index (CCI)

This summarizes all postoperative complications, other than pre-existing complications, in a score from 0 (no complications) to 100 (death). The CCI can be readily computed on the basis of tabulated complications according to the Clavien-Dindo classification [19, 20]

Postoperative pancreatic fistula

Amylase in drain fluid on or after postoperative day 3 of at least three times the upper level of normal serum amylase [21]

 Biochemical leak

Requiring no change in postoperative management, hospital stay not prolonged

 Grade B

Persistent drainage > 3 weeks, change in postoperative management (i.e. catheter drainage, or angiographic procedure for bleeding, signs of infection without organ failure, no relaparotomy), all related to pancreatic fistula

 Grade C

Grade B with reoperation, organ failure or death related to pancreatic fistula

Postoperative bile leakage

Bilirubin in drain fluid on or after postoperative day 3 of at least three times the upper level of normal serum bilirubin (adapted from Koch [22])

Delayed gastric emptying

Adapted from Wente et al [23]

 Grade A

Nasogastric tube postoperative day 4–7 or need for replacement of tube after postoperative day 3; oral intake between day 7 and 14

 Grade B

Nasogastric tube postoperative day 8–14 or need for replacement of tube after postoperative day 7; oral intake between day 14 and 21

 Grade C

Nasogastric tube after postoperative day 14 or need for replacement of tube after postoperative day 14; oral intake after day 14

Gastroenterostomy leakage

As seen on abdominal imaging or during relaparotomy or secretion of fecal material from percutaneous drain or through surgical wound

Acute pancreatitis

Combination of abdominal pain, threefold increased amylase and lipase levels or as seen on radiologic imaging [24]

New-onset diabetes mellitus

Need for insulin or oral diabetes drugs within 3 months after discharge, not present before pancreatoduodenectomy

Exocrine pancreatic insufficiency

Need for oral pancreatic-enzyme supplementation within 3 months after discharge, not present before pancreatoduodenectomy

Body mass index

Weight in kilograms divided by the square of the height in meters

ASA

American Society of Anesthesiologists classification

 I

Healthy patient without systemic disease

 II

Patient with mild systemic disease

 III

Patient with severe systemic disease, limiting activity but not life-threatening