G. Spolverato1, A. Ejaz1, Y. Kim1, B. L. Hall2, K. Bilimoria3, M. Cohen4, C. Ko5, H. Pitt6, T. M. Pawlik1 2Washington University,Department Of Surgery,,St. Louis, MISSOURI, USA 3Northwestern University,Department Of Surgery,Chicago, ILLINOIS, USA 4American College Of Surgeons,Chicago, ILLINOIS, USA 5University Of California Los Angeles,Los Angeles, CALIFORNIA, USA 6Temple University Health Systems,Philadelphia, PENNSYLVANIA, USA 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction: The American College of Surgeons recently added liver-specific variables to the National Surgical Quality Improvement Program (NSQIP). We sought to utilize these variables to define patterns of care, as well as characterize peri-operative outcomes among patients undergoing hepatic resection (HR).
Methods: The ACS-NSQIP database was queried for all patients undergoing HR between January 1, 2013 and October 15, 2013 (n=1,556). Liver-specific variables were summarized.
Results: Preoperatively 10.0% of patients had hepatitis B or C, while 8.9% had cirrhosis. The indication for HR was benign (21.9%) or malignant (78.1%) disease. Among patients with a malignant indication, metastatic disease (63.7%) was more common than primary liver cancer (36.3%); a subset of patients (21.6%) had multiple tumors. Preoperative treatment included neoadjuvant chemotherapy (23.8%), portal vein embolization (2.0%) and intra-arterial therapy (0.8%). At surgery, most patients underwent an open HR (77.9%), while 21.2% and 0.9% underwent a laparoscopic or robotic procedure. The Pringle maneuver was used in 26.4% of patients. While 6.1% of patients had a concomitant hepaticojejunostomy, 10.1% had a concurrent ablation performed with HR. An operative drain was placed in half of patients (50.2%). Among the entire cohort, bile leak (6.6%) and liver insufficiency/failure (3.2%) were relatively uncommon. A subset of patient (9.5%) did experience major liver-specific complications that required intervention (drainage of collection/abscess: 38.4%; stenting for biliary obstruction/leak: 21.2%; bilioma drainage: 18.4%).
Conclusion: In addition to standard NSQIP variables, the new inclusion of liver-specific variables provides a unique opportunity to study national outcomes and practice patterns among patients undergoing HR.