Timing of Complication and Failure to Rescue after Hepatectomy: Single-Institution Analysis of 28-Years of Hepatic Surgery.

Abstract

BACKGROUND\nMorbidity after hepatectomy remains a significant, potentially preventable outcome. Understanding the pattern of complications and rescue pathways is critical for the development of targeted initiatives intended to salvage patients after operative morbidity.\n\n\nSTUDY DESIGN\nPatients undergoing liver resection from 1991-2018 at a single institution were analyzed. Failure-to-rescue (FTR) was defined as percentage of deaths in patients with a complication within 30-days. Generalized estimating equations with log-link function assessed associations between clinical characteristics and major complications and between <30-day and 30-90-day complications. Logistic regression assessed associations between complications and FTR.\n\n\nRESULTS\nA total of 6191 patients and 6668 operations were identified, of which 55.6% were performed for management of metastatic colorectal cancer. Major complications (grade≥3) occurred in 20.2% of operations (1346/6668). 90-day mortality was 2.2%. The most common complication was intra-abdominal abscess at 9.0% (95%CI:8.3-9.7%). 10% of patients with a 30-day complication had another complication between 30-90 days, compared to 2% without an early complication (OR:5.09, 95%CI: 3.97-6.54, p<0.001). FTR for liver failure, cardiac arrest, abscess, and hemorrhage was 36%, 56%, 3%, 6%, respectively. Risk of 90-day mortality was higher in patients with liver failure (53% vs 2%, OR:61.42, 95%CI:37.47-100.67, p<.001), cardiac arrest (69% vs 2%, OR:96.95, 95%CI:33.23-283.80, p<.001), hemorrhage (11% vs 2%, OR:5.51, 95%CI:2.59-11.73, p<.001), and abscess (7% vs 2%, OR:4.05, 95%CI:2.76-5.94, p<.001) compared to those without these complications.\n\n\nCONCLUSIONS\nMorbidity after hepatectomy is frequent despite low mortality. This study identifies targets for improvement in morbidity and failure to rescue after hepatectomy. Efforts to improve recognition and intervention for infections and early complications are needed to improve outcomes.