Risk Factors And Outcomes Associated With Thoracic Complications After Hepatectomy: A Single-Center Experienc
*Mazhar Soufi, *Katelyn Flick, *Duykhanh Ceppa, *Madeline Blackwell, *Rodica Muraru, *Trang K Nguyen, C Max Schmidt, Nicholas zyromski, Michael House, *Attila Nakeeb, Eugene Ceppa
IU, indianapolis, IN
*Mazhar Soufi, *Katelyn Flick, *Duykhanh Ceppa, *Madeline Blackwell, Rodica Muraru, *Trang Nguyen, Attila Nakeeb, Michael House, Christian Max Schmidt, Eugene CeppaIndiana University, Indianapolis, IN
ObjectiveThoracic complications (TC) are a common cause of postoperative morbidity in patients undergoing hepatectomy. This study aimed to identify risk factors, define severity, and evaluate the impact of TCs on postoperative morbidity following hepatectomy.MethodWe used a prospective database in identifying major hepatectomy performed from 2013-2018. The databased was then augmented using extensive review of medical record. Major hepatectomy (MH) was defined by the conventional right or left hemihepatectomy, extended hepatectomy, right posterior sectionectomy, or any consecutive three-segment resection. Severe TC included: acute respiratory failure, pneumothorax, pneumonia, biliopleural fistula, complex pleural effusion, re-intubation, or those requiring invasive intervention. Univariate analysis was used to identify baseline differences. Potential confounders were controlled for in multiple regression models.Results A total of 702 cases were identified. MH 413 (60%) & minor hepatectomy 289 (40%). Patients demonstrated comparable characteristics at baseline except for COPD (TC, 10%; no-TC, 5%; P = 0.045). Severe TC among MH was observed in 38 (13%). Predictors for severe TC requiring intervention included: Post-operative liver failure (PoLF) OR=3, and biliary fistula OR=35, both demonstrating strong p-value <0.001. In addition, the occurrence of severe TC markedly hindered recovery, increasing length of stay (LOS) by 4.4 folds and readmission rates (RA) by 3 folds; p-value for both <0.001. On multivariable analysis risk factors for the development of any TC after hepatectomy are shown in Figure 1. Multivariable analysis revealed that patients developing any postoperative TC had significantly increased postoperative LOS (TC, 11.4 days; no-TC, 5.6 days; P = <0.001) and RA (OR, 2.3; 95% CI, 1.3-4.0; P =0.007). Mortality was similar (1 vs 4 %); P =0.07.ConclusionTCs are major cause of delayed recovery and worse outcomes after hepatectomy. Further, PoLF and biliary fistula can predict the occurrence of severe TC among MJ and the associated needs for readmissions with those complications.
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