Journal article
Does the Surgical Approach Affect the Incidence of Post-Hepatectomy Liver Failure in Cirrhotic Patients? An Analysis of the NSQIP Database
The American surgeon, Vol.90(11), pp.2901-2906
11/2024
DOI: 10.1177/00031348241246175
PMID: 38820223
Abstract
The association between surgical approach and post-hepatectomy liver failure (PHLF) in cirrhotic patients is poorly understood. We hypothesize that patients will have similar rates of liver failure regardless of whether they undergo minimally invasive liver resection (MILR) or open liver resection (OLR) in major liver resections. In contrast, there will be lower rates of PHLF in patients undergoing minor hepatectomy via the MILR approach.
Propensity score matching was used to analyze regression by matching the MILR to the OLR cohort. Patient demographics from the American College of Surgeons National Surgical Quality Improvement Program, including race, age, gender, and ethnicity, were matched. Chronic obstructive pulmonary disease, congestive heart failure, smoking, hypertension, diabetes, renal failure, dyspnea, dialysis dependence, body mass index, and American Society of Anesthesiologists (ASA) classification (>ASA III) were among the preoperative patient characteristics subject to matching. PHLF (Grade A vs B. vs C) was our primary outcome measure.
A total of 2129 cirrhotic patients were included in the study. In the minor hepatectomy group, patients undergoing an OLR were more likely to get discharged to a facility (7.0% vs 4.4%;
= .03), had greater hospital length of stay (5 vs 3 days;
= .02), and had a greater need for invasive postoperative interventions (10.7% vs 4.6%;
< .01). They were also noted to have higher rates of organ space superficial surgical infections (SSIs) (7.3% vs 3.7%;
= .003),
infection (.9% vs .1%;
= .05), renal insufficiency (2.1% vs .1%;
< .01), unplanned intubations (3.1% vs 1.4%;
= .03), and Grade C liver failure (2.3% vs .9%;
= .03).
A higher incidence of PHLF grade C was found in patients undergoing OLR in the minor hepatectomy group. Therefore, in cirrhotic patients who can tolerate minimally invasive approaches, MILR should be offered to prevent postoperative complications as part of their optimization plan.
Details
- Title: Subtitle
- Does the Surgical Approach Affect the Incidence of Post-Hepatectomy Liver Failure in Cirrhotic Patients? An Analysis of the NSQIP Database
- Creators
- Faisal S Jehan - Roswell Park Comprehensive Cancer CenterSangrag Ganguli - University of ChicagoNiklas E Hase - Tufts UniversityAbhinav Seth - University of IowaYong Kwon - University of WashingtonAlan W Hemming - University of IowaHassan Aziz - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The American surgeon, Vol.90(11), pp.2901-2906
- Publisher
- Sage
- DOI
- 10.1177/00031348241246175
- PMID
- 38820223
- eISSN
- 1555-9823
- Language
- English
- Electronic publication date
- 05/31/2024
- Date published
- 11/2024
- Academic Unit
- Surgery
- Record Identifier
- 9984635158202771
Metrics
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