Risk-stratified posthepatectomy pathways based upon the Kawaguchi–Gayet complexity classification and impact on length of stay

Kim, Bradford J.; Arvide, Elsa M.; Gaskill, Cameron; Martin, Allison N.; Kawaguchi, Yoshikuni; Chiang, Yi‐Ju; Dewhurst, Whitney L.; Lee, Teresa; Cao, Hop S. Tran; Chun, Yun Shin; Katz, Matthew H.; Vauthey, Jean Nicolas; Tzeng, Ching‐Wei D.; Newhook, Timothy E.

doi:10.1016/j.sopen.2022.04.006

Cited by 8 publications

(2 citation statements)

References 27 publications

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“…The three‐level complexity classification and surgical approach were associated with the risk of developing treatment requiring complications in patients undergoing liver resection. This implies that the post‐hepatectomy management pathway may be effectively determined by the surgical complexity and approach (i.e., open vs. minimally invasive approaches) 14–17 . The conditional analysis of post‐hepatectomy complications showed that more than 90% of the patients did not develop treatment‐requiring complications on POD 1 or later after minimally invasive grade I resection and on POD 6 or later after open grade I resection.…”

Section: Discussionmentioning

confidence: 99%

“…This implies that the posthepatectomy management pathway may be effectively determined by the surgical complexity and approach (i.e., open vs. minimally invasive approaches). [14][15][16][17] The conditional analysis of post-hepatectomy complications showed that more than 90% of the patients did not develop treatment-requiring complications on POD 1 or later after minimally invasive grade I resection and on POD 6 or later after open grade I resection. Of patients undergoing grade II resection, more than 90% of the patients did not develop treatment-requiring complications on POD 4 or later after minimally invasive resection and POD 7 or later after open resection.…”

Section: Discussionmentioning

confidence: 99%

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A data‐informed timeline for hospital discharge with a reasonably low risk of unplanned readmission after open and minimally invasive liver resections

Kawaguchi,

Ito,

Hayakawa

et al. 2023

J Hepato Biliary Pancreat

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BackgroundPostoperative complications following liver resection remain high, ranging from 20% to 50%. Patients are hospitalized for a certain period of time following liver resection because of the risk of postoperative complications. We hypothesized that the risk of complications decreases with each complication‐free postoperative day after open and minimally invasive liver resections and can be stratified using a recently reported three‐level complexity classification.MethodsPatients undergoing first liver resection without concomitant other organ resections between 2006 and 2019 were included. The three‐level complexity classification was used to categorize liver resection procedures into grades I–III. We assessed the rate of cumulative postoperative complications from the time of liver resection to the time of post‐hepatectomy complications (≥ Clavien–Dindo grade II).ResultsOf the 911 patients included, 200 underwent resection of grade I procedures, 185 underwent resection of grade II procedures, and 526 underwent resection of grade III procedures. The risks of post‐hepatectomy complications changed over time and were stratified by surgical complexity. For patients at the time of liver resection, the estimated 30‐day complication rate was 21.8% for open grade I resection, 26.7% for open grade II resection, 38.4% for open grade III resection, 8.6% for laparoscopic grade I resection, and 12.5% for laparoscopic grade II resection. For patients without complications at 7 days, the estimated 30‐day complication rate decreased to 2.1% for open grade I, 9.2% for open grade II, 17.6% for open grade III, 1.3% for laparoscopic grade I, and 4.5% for laparascopic grade II.ConclusionsThe post‐hepatectomy complication risks were stratified by surgical complexity, liver resection approach, and the period without complication after liver resection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A data‐informed timeline for hospital discharge with a reasonably low risk of unplanned readmission after open and minimally invasive liver resections

Kawaguchi,

Ito,

Hayakawa

et al. 2023

J Hepato Biliary Pancreat

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The Impact of Intraoperative Anesthesiology Provider Handovers on Postoperative Complications After Hepatopancreatobiliary (HPB) Surgery

Guerra‐Londono,

Pham,

Bhutiani

et al. 2024

Journal of Surgical Oncology

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BackgroundThe objective of this study is to assess the possible association between intraoperative anesthesia team handovers and increased 90‐day major complications following HPB surgery.MethodsThis is a single‐center retrospective cohort study of patients who underwent HPB surgery. Anesthesiologist handover (AH) occurred when a complete transfer of care to a receiving anesthesiologist. total anesthesia team handovers (TH) occurred when both anesthesiologist and supervised provider transferred care. The primary outcome was 90‐day major complications, defined as an ACCORDION score of ≥ 3.ResultsNinety‐day major complications occurred in 35 (21.6%) of TH and 96 (21.9%) of AH patients. With adjustment of other covariates, no significant association was found between AH (OR, 1.358, 95% CI, 0.935–1.973, p = 0.1079) or TH (OR, 1.157, 95% CI, 0.706–1.894, p = 0.5633) and 90‐day major complications.ConclusionsIn a high‐volume HPB center, anesthesia team handovers were not associated with an increased risk of patients having a major complication within 90 days after HPB surgery.

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Individual components of post-hepatectomy care pathways have differential impacts on length of stay

Martin¹,

Concors²,

Kim³

et al. 2023

The American Journal of Surgery

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Risk-stratified posthepatectomy pathways based upon the Kawaguchi–Gayet complexity classification and impact on length of stay

Cited by 8 publications

References 27 publications

A data‐informed timeline for hospital discharge with a reasonably low risk of unplanned readmission after open and minimally invasive liver resections

A data‐informed timeline for hospital discharge with a reasonably low risk of unplanned readmission after open and minimally invasive liver resections

The Impact of Intraoperative Anesthesiology Provider Handovers on Postoperative Complications After Hepatopancreatobiliary (HPB) Surgery

Individual components of post-hepatectomy care pathways have differential impacts on length of stay

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