Heather G Lyu1, Gaurav Sharma2, Ethan Y Brovman3, Julius Ejiofor2, Richard D Urman3, Jason S Gold4, Edward E Whang4. 1. Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA; Center for Perioperative Research, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. Electronic address: hlyu@partners.org. 2. Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA; Center for Perioperative Research, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. 3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA; Center for Perioperative Research, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. 4. Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA; Department of Surgery, VA Boston Healthcare System, West Roxbury, MA, USA; Center for Perioperative Research, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND/ PURPOSE: Reoperation is being increasingly utilized as a metric for surgical care quality. The aim of this study was to identify the incidence of and risk factors for unplanned reoperation following index hepatectomy. METHODS: Pre, intra- and post-operative information of patients who underwent partial hepatectomy in 435 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013 were analyzed. RESULTS: 343 (4%) of 9195 patients required reoperation within 30 days of index hepatectomy. The index procedures with the highest incidence of reoperation (%) were trisectionectomy (7%) and right hepatectomy (5%). Patients who underwent reoperation had increased index operative duration (323 ± 174 min versus 243 ± 125 min, p < 0.001), postoperative transfusion (57% versus 23%, p < 0.001), wound complications, cardiorespiratory, renal, thromboembolic, and infectious events. Hemorrhage was the most common indication for reoperation (10%). Male gender, ASA class 4, and right hepatectomy or trisectionectomy were independent predictors of reoperation (OR 1.4 [1.1-1.7], p = 0.007; 2.0 [1.3-3.1], p = 0.003; 1.6 [1.2-2.0], p = 0.001 and 2.5 [1.8-3.4], p < 0.001, respectively). All reoperations occurred during index hospitalization and resulted in longer mean length of stay (19 ± 17 days versus 7 ± 7 days, p < 0.001). CONCLUSION: Reoperation is associated with several patient characteristics and procedural factors in this national sample. Knowledge of these factors can increase awareness of patients at risk for reoperation.
BACKGROUND/ PURPOSE: Reoperation is being increasingly utilized as a metric for surgical care quality. The aim of this study was to identify the incidence of and risk factors for unplanned reoperation following index hepatectomy. METHODS: Pre, intra- and post-operative information of patients who underwent partial hepatectomy in 435 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013 were analyzed. RESULTS: 343 (4%) of 9195 patients required reoperation within 30 days of index hepatectomy. The index procedures with the highest incidence of reoperation (%) were trisectionectomy (7%) and right hepatectomy (5%). Patients who underwent reoperation had increased index operative duration (323 ± 174 min versus 243 ± 125 min, p < 0.001), postoperative transfusion (57% versus 23%, p < 0.001), wound complications, cardiorespiratory, renal, thromboembolic, and infectious events. Hemorrhage was the most common indication for reoperation (10%). Male gender, ASA class 4, and right hepatectomy or trisectionectomy were independent predictors of reoperation (OR 1.4 [1.1-1.7], p = 0.007; 2.0 [1.3-3.1], p = 0.003; 1.6 [1.2-2.0], p = 0.001 and 2.5 [1.8-3.4], p < 0.001, respectively). All reoperations occurred during index hospitalization and resulted in longer mean length of stay (19 ± 17 days versus 7 ± 7 days, p < 0.001). CONCLUSION: Reoperation is associated with several patient characteristics and procedural factors in this national sample. Knowledge of these factors can increase awareness of patients at risk for reoperation.
Authors: Neel R Sangal; Kalin Nishimori; Eric Zhao; Sana H Siddiqui; Soly Baredes; Richard Chan Woo Park Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-11-01 Impact factor: 6.223
Authors: Jordan M Cloyd; Takashi Mizuno; Yoshikuni Kawaguchi; Heather A Lillemoe; Georgios Karagkounis; Kiyohiko Omichi; Yun Shin Chun; Claudius Conrad; Ching-Wei D Tzeng; Bruno C Odisio; Steven Y Huang; Marshall Hicks; Steven H Wei; Thomas A Aloia; Jean-Nicolas Vauthey Journal: Ann Surg Date: 2020-04 Impact factor: 13.787