TY - JOUR
T1 - Comprehensive Complication Index Validates Improved Outcomes over Time despite Increased Complexity in 3707 Consecutive Hepatectomies
AU - Cloyd, Jordan M.
AU - Mizuno, Takashi
AU - Kawaguchi, Yoshikuni
AU - Lillemoe, Heather A.
AU - Karagkounis, Georgios
AU - Omichi, Kiyohiko
AU - Chun, Yun Shin
AU - Conrad, Claudius
AU - Tzeng, Ching Wei D.
AU - Odisio, Bruno C.
AU - Huang, Steven Y.
AU - Hicks, Marshall
AU - Wei, Steven H.
AU - Aloia, Thomas A.
AU - Vauthey, Jean Nicolas
N1 - Funding Information:
From the *Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; and †Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX. Drs. Cloyd and Mizuno contributed equally to this work. This research was supported in part by the National Institutes of Health through MD Anderson Cancer Center’s Cancer Center Support Grant, CA016672. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.annalsofsurgery.com). Reprints: Jean-Nicolas Vauthey, MD, FACS, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX 77030. E-mail: jvauthey@mdanderso-n.org. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/18/27104-0724 DOI: 10.1097/SLA.0000000000003043
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Objective:The aim of this study was to evaluate trends over time in perioperative outcomes for patients undergoing hepatectomy.Background:As perioperative care and surgical technique for hepatectomy have improved, the indications for and complexity of liver resections have evolved. However, the resulting effect on the short-term outcomes over time has not been well described.Methods:Consecutive patients undergoing hepatectomy during 1998 to 2015 at 1 institution were analyzed. Perioperative outcomes, including the comprehensive complication index (CCI), were compared between patients who underwent hepatectomy in the eras 1998 to 2003, 2004 to 2009, and 2010 to 2015.Results:The study included 3707 hepatic resections. The number of hepatectomies increased in each era (794 in 1998 to 2003, 1402 in 2004 to 2009, and 1511 in 2010 to 2015). Technical complexity increased over time as evidenced by increases in the rates of major hepatectomy (20%, 23%, 30%, P < 0.0001), 2-stage hepatectomy (0%, 3%, 4%, P < 0.001), need for portal vein embolization (5%, 9%, 9%, P = 0.001), preoperative chemotherapy for colorectal liver metastases (70%, 82%, 89%, P < 0.001) and median operative time (180, 175, 225 minutes, P < 0.001). Significant decreases over time were observed in median blood loss (300, 250, 200 mL, P < 0.001), transfusion rate (19%, 15%, 5%, P < 0.001), median length of hospitalization (7, 7, 6 days, P < 0.001), rates of CCI ≥26.2 (20%, 22%, 16%, P < 0.001) and 90-day mortality (3.1%, 2.6%, 1.3%, P < 0.01). On multivariable analysis, hepatectomy in the most recent era 2010 to 2015 was associated with a lower incidence of CCI ≥26.2 (odds ratio 0.7, 95% confidence interval 0.6-0.8, P < 0.0001).Conclusion:Despite increases in complexity over an 18-year period, continued improvements in surgical technique and perioperative outcomes yielded a resultant decrease in CCI in the most current era.
AB - Objective:The aim of this study was to evaluate trends over time in perioperative outcomes for patients undergoing hepatectomy.Background:As perioperative care and surgical technique for hepatectomy have improved, the indications for and complexity of liver resections have evolved. However, the resulting effect on the short-term outcomes over time has not been well described.Methods:Consecutive patients undergoing hepatectomy during 1998 to 2015 at 1 institution were analyzed. Perioperative outcomes, including the comprehensive complication index (CCI), were compared between patients who underwent hepatectomy in the eras 1998 to 2003, 2004 to 2009, and 2010 to 2015.Results:The study included 3707 hepatic resections. The number of hepatectomies increased in each era (794 in 1998 to 2003, 1402 in 2004 to 2009, and 1511 in 2010 to 2015). Technical complexity increased over time as evidenced by increases in the rates of major hepatectomy (20%, 23%, 30%, P < 0.0001), 2-stage hepatectomy (0%, 3%, 4%, P < 0.001), need for portal vein embolization (5%, 9%, 9%, P = 0.001), preoperative chemotherapy for colorectal liver metastases (70%, 82%, 89%, P < 0.001) and median operative time (180, 175, 225 minutes, P < 0.001). Significant decreases over time were observed in median blood loss (300, 250, 200 mL, P < 0.001), transfusion rate (19%, 15%, 5%, P < 0.001), median length of hospitalization (7, 7, 6 days, P < 0.001), rates of CCI ≥26.2 (20%, 22%, 16%, P < 0.001) and 90-day mortality (3.1%, 2.6%, 1.3%, P < 0.01). On multivariable analysis, hepatectomy in the most recent era 2010 to 2015 was associated with a lower incidence of CCI ≥26.2 (odds ratio 0.7, 95% confidence interval 0.6-0.8, P < 0.0001).Conclusion:Despite increases in complexity over an 18-year period, continued improvements in surgical technique and perioperative outcomes yielded a resultant decrease in CCI in the most current era.
KW - colorectal liver metastasis
KW - liver resection
KW - morbidity
KW - mortality
KW - surgery
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U2 - 10.1097/SLA.0000000000003043
DO - 10.1097/SLA.0000000000003043
M3 - Article
C2 - 30339628
AN - SCOPUS:85082146383
SN - 0003-4932
VL - 271
SP - 724
EP - 731
JO - Annals of surgery
JF - Annals of surgery
IS - 4
ER -