Priya Pathak1, Diamantis I Tsilimigras1, J Madison Hyer1, Adrian Diaz1, Timothy M Pawlik2. 1. Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA. 2. Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA. tim.pawlik@osumc.edu.
Abstract
BACKGROUND: The effect of varying severity and timing of complications after hepatic resection on 30-day mortality has not been thoroughly examined. METHODS: National Surgical Quality Improvement Program Patient User Files (NSQIP-PUF) were used to identify patients who underwent elective hepatic resection between 2014 and 2019. The impact of number, timing, and severity of complications on 30-day mortality was examined. RESULTS: Among 25,084 patients who underwent hepatic resection, 7436 (29.9%) patients developed at least one NSQIP complication, while 2688 (10.7%) had multiple (≥2) complications. Overall, 30-day mortality was 1.7% (n=424), among whom 81.4% (n=345) patients had ≥2 complications. The 30-day mortality was highest among patients with three consecutive severe complications (47.8%), as well as patients with one non-severe and two subsequent severe complications (47.6%). The adjusted probability of 30-day mortality was 35.5% (95%CI: 29.5-41.4%) when multiple severe complications occurred within the first postoperative week and 16.2% (95%CI: 7.2-25.1%) when the second severe complication occurred at least one week apart. The adjusted risk of 30-day mortality after even two non-severe complications was as high as 5.3% (95%CI: 3.7-6.9%) when the second complication occurred within a week postoperatively. CONCLUSION: Approximately 1 in 10 patients developed multiple complications following hepatectomy. Timing and severity of complications were independently associated with 30-day mortality.
BACKGROUND: The effect of varying severity and timing of complications after hepatic resection on 30-day mortality has not been thoroughly examined. METHODS: National Surgical Quality Improvement Program Patient User Files (NSQIP-PUF) were used to identify patients who underwent elective hepatic resection between 2014 and 2019. The impact of number, timing, and severity of complications on 30-day mortality was examined. RESULTS: Among 25,084 patients who underwent hepatic resection, 7436 (29.9%) patients developed at least one NSQIP complication, while 2688 (10.7%) had multiple (≥2) complications. Overall, 30-day mortality was 1.7% (n=424), among whom 81.4% (n=345) patients had ≥2 complications. The 30-day mortality was highest among patients with three consecutive severe complications (47.8%), as well as patients with one non-severe and two subsequent severe complications (47.6%). The adjusted probability of 30-day mortality was 35.5% (95%CI: 29.5-41.4%) when multiple severe complications occurred within the first postoperative week and 16.2% (95%CI: 7.2-25.1%) when the second severe complication occurred at least one week apart. The adjusted risk of 30-day mortality after even two non-severe complications was as high as 5.3% (95%CI: 3.7-6.9%) when the second complication occurred within a week postoperatively. CONCLUSION: Approximately 1 in 10 patients developed multiple complications following hepatectomy. Timing and severity of complications were independently associated with 30-day mortality.