Kosuke Kobayashi1, Yoshikuni Kawaguchi2, Michael Schneider3, Giulia Piazza3, Ismail Labgaa3, Joliat Gaëtan-Romain3, Emmanuel Melloul3, Emilie Uldry3, Nicolas Demartines4, Nermin Halkic3. 1. Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Switzerland; Hepato-Pancreatico-Biliary Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo. Electronic address: kkobayashi-tki@umin.ac.jp. 2. Hepato-Pancreatico-Biliary Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo. 3. Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Switzerland. 4. Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Switzerland. Electronic address: demartines@chuv.ch.
Abstract
BACKGROUND: The present study aimed to assess performance of the three-level complexity classification which stratified liver resection procedures into three complexity grades (grade I, low; grade II, intermediate; grade III, high complexity) and to evaluate whether the enhanced recovery after surgery (ERAS) protocol improves postoperative outcomes for each complexity grade. STUDY DESIGN: Consecutive patients undergoing open liver resection (OLR) and laparoscopic liver resection (LLR) at Lausanne University Hospital during 2010-2020 were assessed. RESULTS: A total of 437 patients were included. Operative time estimated blood loss, and length of hospital stay increased significantly with a stepwise increase of the grades from I to III in OLR and LLR (all, P<0.05). The same trend for comprehensive complication index (CCI) was found in OLR (P<0.005). Age (P=0.004), the three-level complexity classification (grade II vs. I, P=0.001; grade III vs. I, P<0.001), no use of the ERAS protocol (P=0.016), and biliary reconstruction (P<0.001) were significant predictors for postoperative complication defined as CCI ≥ 26.2 in a multivariable logistic regression analysis. The prediction model incorporating the 4 factors had a calculated concordance index of 0.735 and 0.742 based on the bootstrapping method. The use of ERAS protocol was associated with lower probability of postoperative complication for each complexity grade and age. CONCLUSION: The use of ERAS protocol may decrease the probability of postoperative complication for each surgical complexity of liver resection and patient age. This finding emphasized the importance for tailoring perioperative managements by surgical complexity and patient age to improve outcomes after liver resection.
BACKGROUND: The present study aimed to assess performance of the three-level complexity classification which stratified liver resection procedures into three complexity grades (grade I, low; grade II, intermediate; grade III, high complexity) and to evaluate whether the enhanced recovery after surgery (ERAS) protocol improves postoperative outcomes for each complexity grade. STUDY DESIGN: Consecutive patients undergoing open liver resection (OLR) and laparoscopic liver resection (LLR) at Lausanne University Hospital during 2010-2020 were assessed. RESULTS: A total of 437 patients were included. Operative time estimated blood loss, and length of hospital stay increased significantly with a stepwise increase of the grades from I to III in OLR and LLR (all, P<0.05). The same trend for comprehensive complication index (CCI) was found in OLR (P<0.005). Age (P=0.004), the three-level complexity classification (grade II vs. I, P=0.001; grade III vs. I, P<0.001), no use of the ERAS protocol (P=0.016), and biliary reconstruction (P<0.001) were significant predictors for postoperative complication defined as CCI ≥ 26.2 in a multivariable logistic regression analysis. The prediction model incorporating the 4 factors had a calculated concordance index of 0.735 and 0.742 based on the bootstrapping method. The use of ERAS protocol was associated with lower probability of postoperative complication for each complexity grade and age. CONCLUSION: The use of ERAS protocol may decrease the probability of postoperative complication for each surgical complexity of liver resection and patient age. This finding emphasized the importance for tailoring perioperative managements by surgical complexity and patient age to improve outcomes after liver resection.
Authors: Hilla Mills; Ronald Acquah; Nova Tang; Luke Cheung; Susanne Klenk; Ronald Glassen; Magali Pirson; Alain Albert; Duong Trinh Hoang; Thang Nguyen Van Journal: Front Surg Date: 2022-06-14