Perioperative complications and the cost of rescue or failure to rescue in hepato-pancreato-biliary surgery

Chen, Qinyu; Beal, Eliza W.; Kimbrough, Charles W.; Bagante, Fabio; Merath, Katiuscha; Dillhoff, Mary; Schmidt, Carl; White, Susan; Cloyd, Jordan M.; Pawlik, Timothy M.

doi:10.1016/j.hpb.2018.03.010

Cited by 35 publications

(23 citation statements)

References 39 publications

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“…21 Furthermore, among patients undergoing hepatopancreatic surgery, a significant cost has been associated with failure-to-rescue patients from perioperative complications. [22][23][24] Data from the current study demonstrate that the most common complications during the index hospitalization following liver resection were pulmonary and acute renal failure. Interestingly, within 30-and 90-days of discharge, patients were more likely to present with these complications, as well as other complications such as deep vein thrombosis/pulmonary embolism.…”

Section: Discussionmentioning

confidence: 67%

Skilled nursing facility (SNF) utilization and impact of SNF star-quality ratings on outcomes following hepatectomy among Medicare beneficiaries

Paredes

Hyer

Tsilimigras

et al. 2020

HPB

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Background: An increasing number of patients require admission to a skilled nursing facility (SNF) following surgery. However, the impact of SNF quality on post-operative outcomes is unknown. Methods: The Medicare Standard Analytic Files and Nursing Home Compare Dataset were used to define SNF utilization and determine the influence of SNF star quality ratings on outcomes following hepatectomy.Results: Among 7256 Medicare beneficiaries, 918 (12.7%) required. Compared to patients discharged home, individuals discharged to SNF were older (median age: 75 [IQR 71-80] vs. 71 [IQR 68-76] years), and had a higher incidence of complications such as pulmonary failure, pneumonia, and acute renal failure during index hospitalization (all p < 0.05). Patients sent to a SNF were more likely to be readmitted within 30-days (30.1% vs. 13.4%, p < 0.001). The incidence of new complications within 30-and 90-days of discharge was similar regardless of star quality ratings (all p > 0.05). On multivariable analysis, Charlson comorbidity score 3 was the factor most strongly associated with 30-day readmission (OR 1.32-15.29, p = 0.016). Conclusion:While post-discharge outcomes were similar across SNF quality ratings, roughly one in three Medicare patients discharged to a SNF were readmitted within 30-days.

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Section: Discussionmentioning

confidence: 67%

Skilled nursing facility (SNF) utilization and impact of SNF star-quality ratings on outcomes following hepatectomy among Medicare beneficiaries

Paredes

Hyer

Tsilimigras

et al. 2020

HPB

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“…Decreasing postoperative 30-day morbidity and 30-day mortality are first priority after surgical procedures and specifically liver surgery in order to decrease the impact of complications on quality of life, oncological outcomes and costs. [19][20][21][22][23] Several reports show that complications after liver surgery impact the long-term survival and should be minimized. 24,25 Using an approach that decreases complications should therefore always be considered in such patients.…”

Section: Discussionmentioning

confidence: 99%

Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study

Elfrink

Nieuwenhuizen

Tol

et al. 2021

HPB

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Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery. Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy. Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.

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“…23,24 The issue of quality is particularly germane to hepatopancreatic-biliary surgery, which often involves complex procedures and post-operative morbidity reportedly ranging from 15 to 50%. 25,26 However, the range of morbidity following liver 1146 HPB surgery that is "acceptable," as well as a consensus definition of what constitutes a minimum level of quality relative to liver surgery, are still debated. Rössler et al proposed "benchmarks" to define the "optimal" outcomes after liver surgery using the short-term outcomes of LD patients who underwent LH or RH.…”

Section: Discussionmentioning

confidence: 99%

Complications after liver surgery: a benchmark analysis

Bagante

Ruzzenente

Beal

et al. 2019

HPB

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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 riskadjusted 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.

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Perioperative complications and the cost of rescue or failure to rescue in hepato-pancreato-biliary surgery

Abstract: Following HPB surgery, there is a significant cost associated with both rescue and failure-to-rescue from perioperative complications. Total hospitalization cost was highest for patients who experienced failure-to-rescue.

Cited by 35 publications

References 39 publications

Skilled nursing facility (SNF) utilization and impact of SNF star-quality ratings on outcomes following hepatectomy among Medicare beneficiaries

Skilled nursing facility (SNF) utilization and impact of SNF star-quality ratings on outcomes following hepatectomy among Medicare beneficiaries

Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study

Complications after liver surgery: a benchmark analysis

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