Allison N Martin1, Sowmya Narayanan1, Florence E Turrentine1,2, Todd W Bauer1,3, Reid B Adams1,3, George J Stukenborg1,2, Victor M Zaydfudim4,5,6. 1. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 2. Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA. 3. Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, VA, USA. 4. Department of Surgery, University of Virginia, Charlottesville, VA, USA. vz8h@virginia.edu. 5. Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA. vz8h@virginia.edu. 6. Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, VA, USA. vz8h@virginia.edu.
Abstract
BACKGROUND: Despite technical advances, bile leak remains a significant complication after hepatectomy. The current study uses a targeted multi-institutional dataset to characterize perioperative factors that are associated with bile leakage after hepatectomy to better understand the impact of bile leak on morbidity and mortality. METHODS: Adult patients in the 2014-2015 ACS NSQIP targeted hepatectomy dataset were linked to the ACS NSQIP PUF dataset. Bivariable and multivariable regression analyses were used to assess the associations between clinical factors and post-hepatectomy bile leak. RESULTS: Of 6859 patients, 530 (7.7%) had a postoperative bile leak. Proportion of bile leaks was significantly greater in patients after major compared to minor hepatectomy (12.6 vs. 5.1%, p < 0.001). The proportion of patients with bile leak was significantly greater in patients after major hepatectomy who had concomitant enterohepatic reconstruction (31.8 vs. 10.1%, p < 0.001). Postoperative mortality was significantly greater in patients with bile leaks (6.0 vs. 1.7%, p < 0.001). After adjusting for significant covariates, bile leak was independently associated with increased risk of postoperative morbidity (OR = 4.55; 95% CI 3.72-5.56; p < 0.001). After adjusting for significant effects of postoperative complications, liver failure, and reoperation (all p<0.001), bile leak was not independently associated with increased risk of postoperative mortality (p = 0.262). CONCLUSION: Major hepatectomy and enterohepatic biliary reconstruction are associated with significantly greater rates of bile leak after liver resection. Bile leak is independently associated with significant postoperative morbidity. Mitigation of bile leak is critical in reducing morbidity and mortality after liver resection.
BACKGROUND: Despite technical advances, bile leak remains a significant complication after hepatectomy. The current study uses a targeted multi-institutional dataset to characterize perioperative factors that are associated with bile leakage after hepatectomy to better understand the impact of bile leak on morbidity and mortality. METHODS: Adult patients in the 2014-2015 ACS NSQIP targeted hepatectomy dataset were linked to the ACS NSQIP PUF dataset. Bivariable and multivariable regression analyses were used to assess the associations between clinical factors and post-hepatectomy bile leak. RESULTS: Of 6859 patients, 530 (7.7%) had a postoperative bile leak. Proportion of bile leaks was significantly greater in patients after major compared to minor hepatectomy (12.6 vs. 5.1%, p < 0.001). The proportion of patients with bile leak was significantly greater in patients after major hepatectomy who had concomitant enterohepatic reconstruction (31.8 vs. 10.1%, p < 0.001). Postoperative mortality was significantly greater in patients with bile leaks (6.0 vs. 1.7%, p < 0.001). After adjusting for significant covariates, bile leak was independently associated with increased risk of postoperative morbidity (OR = 4.55; 95% CI 3.72-5.56; p < 0.001). After adjusting for significant effects of postoperative complications, liver failure, and reoperation (all p<0.001), bile leak was not independently associated with increased risk of postoperative mortality (p = 0.262). CONCLUSION: Major hepatectomy and enterohepatic biliary reconstruction are associated with significantly greater rates of bile leak after liver resection. Bile leak is independently associated with significant postoperative morbidity. Mitigation of bile leak is critical in reducing morbidity and mortality after liver resection.
Entities:
Keywords:
Bile leak; Biliary complication; Drain; Hepatectomy; Liver resection; Major hepatectomy; Morbidity and mortality
Authors: Vangelis G Alexiou; Thomas Tsitsias; Michael N Mavros; Gavin S Robertson; Timothy M Pawlik Journal: Surg Innov Date: 2012-12-14 Impact factor: 2.058
Authors: Giuseppe Zimmitti; Robert E Roses; Andreas Andreou; Junichi Shindoh; Steven A Curley; Thomas A Aloia; Jean-Nicolas Vauthey Journal: J Gastrointest Surg Date: 2012-09-07 Impact factor: 3.452
Authors: George Van Buren; Mark Bloomston; Steven J Hughes; Jordan Winter; Stephen W Behrman; Nicholas J Zyromski; Charles Vollmer; Vic Velanovich; Taylor Riall; Peter Muscarella; Jose Trevino; Attila Nakeeb; C Max Schmidt; Kevin Behrns; E Christopher Ellison; Omar Barakat; Kyle A Perry; Jeffrey Drebin; Michael House; Sherif Abdel-Misih; Eric J Silberfein; Steven Goldin; Kimberly Brown; Somala Mohammed; Sally E Hodges; Amy McElhany; Mehdi Issazadeh; Eunji Jo; Qianxing Mo; William E Fisher Journal: Ann Surg Date: 2014-04 Impact factor: 12.969
Authors: Alison A Smith; Dominique J Monlezun; John Martinie; David Iannitti; Ioannis Konstantinidis; Michael Darden; Geoffrey Parker; Yuman Fong; Joseph F Buell Journal: World J Surg Date: 2020-05 Impact factor: 3.352
Authors: Vinzent N Spetzler; Marlene Schepers; Hans O Pinnschmidt; Lutz Fischer; Björn Nashan; Jun Li Journal: Hepatobiliary Surg Nutr Date: 2019-04 Impact factor: 7.293
Authors: Jan Bednarsch; Zoltan Czigany; Daniel Heise; Sven Arke Lang; Steven W M Olde Damink; Tom Luedde; Philipp Bruners; Tom Florian Ulmer; Ulf Peter Neumann Journal: J Clin Med Date: 2020-05-08 Impact factor: 4.241