TY - JOUR
T1 - Risk Factors for Complications Requiring Interventional Radiological Treatment After Hepatectomy
AU - Kolarich, Andrew R.
AU - Solomon, Alex J.
AU - Weiss, Matthew J.
AU - Philosophe, Benjamin
AU - Weiss, Clifford R.
AU - Hong, Kelvin
N1 - Publisher Copyright:
© 2020, The Society for Surgery of the Alimentary Tract.
PY - 2021/5
Y1 - 2021/5
N2 - Purpose: To identify perioperative factors that are significantly associated with complications requiring interventional radiology (IR) treatment after hepatectomy. Methods: We retrospectively reviewed data from 11,243 patients in the USA who underwent hepatectomy from 2014 to 2016 using the National Surgical Quality Improvement Program database. Data on the following IR procedures were extracted: abscess drain placement, endovascular treatment for bleeding, and postoperative percutaneous biliary drain (PBD) placement up to 30 days postoperatively. Patients’ clinical and intraoperative factors were examined. Population, univariate, and multivariable analyses were performed. P < 0.05 was considered significant. Results: A total of 704 patients (6%) required IR treatment postoperatively, and 10,539 patients (94%) did not. On multivariable analysis, biliary reconstruction was a significant predictor of postoperative abscess drain placement (hazard ratio (HR), 3.5; 95% confidence interval (CI) 1.8, 6.5; P <.001), endovascular treatment for bleeding (HR, 3.3; 95% CI 1.4, 7.8 P =.006), and postoperative PBD placement (HR, 2.9; 95% CI 1.9, 4.2; P <.001). Compared with hepatectomy without biliary reconstruction, hepatectomy with biliary reconstruction was associated with significantly higher rates of complications treated with IR procedures (26% vs. 4.9%) and death within 30 days (6.0% vs. 1.2%) (both, P <.001). Conclusion: Biliary reconstruction is a strong predictor of the need for postoperative IR treatment after hepatectomy. One in four patients who underwent biliary reconstruction required IR treatment of a complication during the first 30 days after hepatectomy.
AB - Purpose: To identify perioperative factors that are significantly associated with complications requiring interventional radiology (IR) treatment after hepatectomy. Methods: We retrospectively reviewed data from 11,243 patients in the USA who underwent hepatectomy from 2014 to 2016 using the National Surgical Quality Improvement Program database. Data on the following IR procedures were extracted: abscess drain placement, endovascular treatment for bleeding, and postoperative percutaneous biliary drain (PBD) placement up to 30 days postoperatively. Patients’ clinical and intraoperative factors were examined. Population, univariate, and multivariable analyses were performed. P < 0.05 was considered significant. Results: A total of 704 patients (6%) required IR treatment postoperatively, and 10,539 patients (94%) did not. On multivariable analysis, biliary reconstruction was a significant predictor of postoperative abscess drain placement (hazard ratio (HR), 3.5; 95% confidence interval (CI) 1.8, 6.5; P <.001), endovascular treatment for bleeding (HR, 3.3; 95% CI 1.4, 7.8 P =.006), and postoperative PBD placement (HR, 2.9; 95% CI 1.9, 4.2; P <.001). Compared with hepatectomy without biliary reconstruction, hepatectomy with biliary reconstruction was associated with significantly higher rates of complications treated with IR procedures (26% vs. 4.9%) and death within 30 days (6.0% vs. 1.2%) (both, P <.001). Conclusion: Biliary reconstruction is a strong predictor of the need for postoperative IR treatment after hepatectomy. One in four patients who underwent biliary reconstruction required IR treatment of a complication during the first 30 days after hepatectomy.
KW - Biliary drain
KW - Biliary reconstruction
KW - Embolization
KW - Hepatectomy
KW - National Surgical Quality Improvement Program
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U2 - 10.1007/s11605-020-04609-3
DO - 10.1007/s11605-020-04609-3
M3 - Article
C2 - 32462493
AN - SCOPUS:85085502538
SN - 1091-255X
VL - 25
SP - 1184
EP - 1192
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 5
ER -