M. Tenet1,2, D. Stefanov1, F. Del Rio1,2, N. Robey1,2, G. Vitiello1,2 1Northwell, New Hyde Park, NEW YORK, USA 2South Shore University Hospital, Surgery, Bay Shore, NY, USA
Introduction: Albumin-bilirubin (ALBI) score predicts survival in patients with chronic liver disease. The impact of ALBI score on surgical outcomes, however, is less well-defined. We hypothesized that elevated preoperative ALBI score is associated with higher rates of post-hepatectomy liver failure (PHLF), bile leaks and wound infections.
Methods: The 2020 American College of Surgeons National Surgical Quality Improvement Program Targeted Hepatectomy file was utilized to identify patients undergoing open and minimally invasive (robotic + laparoscopic) hepatectomy for HCC, cholangiocarcinoma, and colorectal liver metastases. Preoperative ALBI score was defined as (log10 (bilirubin × 0.66) + (albumin) × −0.0852). Four grades of ALBI score were created using the median (IQR) of -0.5 (-0.6 to -0.4) as cut off points. Three logistic regression models with backward elimination were created to associate ALBI score with PHLF, bile leaks, and wound infections.
Results: 4404 patients were included in analysis. Median age was 62 years (52-70), and median BMI was 28 (24-32). PHLF, bile leaks, and wound infections were observed in 155 (3.5%), 267 (6.2%), 407 (9.2%) patients, respectively. ALBI was independently associated with PHLF, with the highest quartile demonstrating a 2.5 times higher odds of PHLF than the lowest quartile (6.6% vs 1.9%, OR=2.48, 95% CI:1.4-4.37, p=0.0017). ALBI was not independently associated with bile leaks or wound infections. Notably, when controlling for other clinical risk factors, minimally invasive hepatectomy was independently associated with reduced rate of PHLF (OR=0.45, 95% CI:0.26-0.77, p=0.0038), bile leaks (OR=0.66, 95% CI:0.45-0.97, p=0.0332), and wound infections (OR=0.57, 95% CI:0.42-0.78, p=0.0005).
Conclusion: Increased ALBI score is significantly associated with PHLF, but not bile leaks or wound infections, after liver resection for HCC, cholangiocarcinoma, and CRLM. Minimally invasive liver surgery is associated with reduced PHLF, bile leaks, and wound infections when controlling for other known clinical risk factors.