Complications after liver surgery: a benchmark analysis.
Fabio Bagante,Andrea Ruzzenente,Eliza W. Beal,Tommaso Campagnaro,Katiuscha Merath,Simone Conci,Ozgur Akgul,Sorin Alexandrescu,Hugo Marques,Vincent W. T. Lam,Feng Shen,George A. Poultsides,Olivier Soubrane,Guillaume Martel,Calogero Iacono,Alfredo Guglielmi,Timothy M. Pawlik +16 more
TLDR
Risk-adjusted BMVs are likely much more applicable and appropriate in assessing "acceptable" benchmark outcomes following liver surgery as well as other factors influence the risk of complications following hepatectomy.Abstract:
Background The best achievable short-term outcomes after liver surgery have not been identified. Several factors may influence the post-operative course of patients undergoing hepatectomy increasing the risk of post-operative complications. We sought to identify risk-adjusted benchmark values [BMV] for liver surgery. Methods The National Surgery Quality Improvement Program (NSQIP) database was used to develop Bayesian models to estimate risk-adjusted BMVs for overall and liver related (post-hepatectomy liver failure [PHLF], biliary leakage [BL]) complications. A separate international multi-institutional database was used to validate the risk-adjusted BMVs. Results Among the 11,243 patients included in the NSQIP database, the incidence of complications, PHLF, and BL was 36%, 5%, and 8%, respectively. The risk-adjusted BMVs for complication (range, 16–72%), PHLF (range, 1%–20%), and BL (range, 4%–22%) demonstrated a high variability based on patients characteristics. When tested using an international database including nine institutes, the risk-adjusted BMVs for complications ranged from 26% (Institute-4) to 43% (Institute-1), BMVs for PHLF between 3% (Institute-3) and 12% (Institute-5), while BMVs for BL ranged between 5% (Institute-4) and 9% (Institute-7). Conclusions Multiple factors influence the risk of complications following hepatectomy. Risk-adjusted BMVs are likely much more applicable and appropriate in assessing “acceptable” benchmark outcomes following liver surgery.read more
Citations
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Benchmarking in surgery: how to compare with the best.
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Early postoperative serum aspartate aminotransferase for prediction of post-hepatectomy liver failure
TL;DR: In this paper , the associations between early postoperative (POD1) serum aminotransferase levels and post-hepatectomy liver failure (PHLF) were determined.
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Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies
TL;DR: In this article , the authors investigated the association between body mass index and postoperative outcomes after laparoscopic major hepatectomies and found a statistically significant increase in open conversion rate (16.3%, 10.8%, 9.2%, and 5.6%), longer operation time (320 vs 305 vs 300 and 266 minutes, P < .001), increasing blood loss (300 vs 300 vs 295 vs 250 mL, P = .022), and higher postoperative morbidity (33.4% vs 26.3% vs 25.0%
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Therapiekonzepte bei hepatischer Echinokokkose
Maximilian Denzinger,Nadir Nasir,Kira Steinkraus,Christoph Michalski,Felix J Hüttner,Benno Traub +5 more
TL;DR: In this article , the authors discuss the use of minimally invasive surgery with reduced morbidity and mortality has justified surgical resection for a broader set of patients; however, minimally-invasive surgery requires a high level of expertise and optimal perioperative planning.
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