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Assessing textbook outcomes following major liver surgery in association with obesity at a referral academic center

Introduction - Outcomes of major surgeries in tertiary educational hospitals have been complicated by the referral of high-risk patients and the participation of trainees in surgical procedures. We analyzed outcomes of major hepatectomies in a tertiary academic setting emphasizing the role of traini...

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Main Authors: Khajeh, Elias (Author) , Fakour, Sanam (Author) , Ünal, Umut Kaan (Author) , Sabetkish, Nastaran (Author) , Leins, Johannes (Author) , Ramouz, Ali (Author) , Mieth, Markus (Author) , Sabagh, Mohammad Sadegh (Author) , Abbasi Dezfouli, Sepehr (Author) , Golriz, Mohammad (Author) , Büchler, Markus W. (Author) , Mehrabi, Arianeb (Author)
Format: Article (Journal)
Language:English
Published: November 2023
In: European journal of surgical oncology
Year: 2023, Volume: 49, Issue: 11, Pages: 1-7
ISSN:1532-2157
DOI:10.1016/j.ejso.2023.107080
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ejso.2023.107080
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0748798323007187
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Author Notes:Elias Khajeh, Sanam Fakour, Umut Kaan Ünal, Nastaran Sabetkish, Johannes Leins, Ali Ramouz, Markus Mieth, Mohammadsadegh Sabagh, Sepehr Abbasi Dezfouli, Mohammad Golriz, Markus W. Büchler, Arianeb Mehrabi
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Summary:Introduction - Outcomes of major surgeries in tertiary educational hospitals have been complicated by the referral of high-risk patients and the participation of trainees in surgical procedures. We analyzed outcomes of major hepatectomies in a tertiary academic setting emphasizing the role of training and obesity on textbook outcomes (TO). - Materials and methods - 971 adult patients who underwent open major hepatectomy (Mesohepatectomy [n = 111], hemihepatectomy [n = 610], and extended hepatectomy [n = 250]) were evaluated. A TO was defined as: a negative resection margin, no grade B/C bile leak, no major complications, no in-hospital mortality, and no 30-day readmission. TOs were compared following operations performed by senior surgeons and those performed by junior surgeons under the supervision of senior surgeons and between patients with and without obesity. - Results - TO was achieved in 70.1% of patients overall (78.4% in mesohepatectomy, 73.1% in hemihepatectomy, and 59.2% in extended hepatectomy). The rate of TO was similar following operations performed by and supervised by a senior surgeon (69.3% vs 71.0%, p = 0.570). The rate of TO was significantly lower in patients with obesity (41.5% vs 74.6%, p < 0.001). Factors including increased age (odds ratio [OR] for 10-year increase = 0.83, 95% confidence interval [CI]: 0.73-0.96, p = 0.009), obesity (OR = 0.25, 95%CI: 0.16-0.37, p < 0.001), biliodigestive anastomosis (OR = 0.27, 95%CI: 0.19-0.40, p < 0.001), and portal vein resection (OR = 0.49, 95%CI: 0.28-0.87, p = 0.014) lower the rate of TO. - Conclusion - Promising outcomes are possible after major hepatectomy in an academic setting. Obese patients and those undergoing more complex surgeries had a higher risk of poor postoperative outcomes.
Item Description:Online verfügbar: 15. September 2023, Artikelversion: 20. September 2023
Gesehen am 18.12.2023
Physical Description:Online Resource
ISSN:1532-2157
DOI:10.1016/j.ejso.2023.107080

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