Current Pattern of Use and Impact of Pringle Maneuver in Liver Resections in the United States

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Abstract

Background: Pringle maneuver (PM) is used for inflow vascular control during hepatectomy, but its use remains controversial. We aimed to report its pattern of use and association with postoperative outcomes. Methods: We identified hepatectomy patients using the liver-targeted National Surgical Quality Improvement Program database (2014-2016). Associations between PM and posthepatectomy liver failure (PHLF), receipt of blood transfusion, and total hospital length of stay (LOS) were evaluated. Results: We identified 7870 patients (74.9%) with no Pringle maneuver and 2632 (25.1%) with PM. PM patients were older (median age 61 versus 60 y, P = 0.002) and had higher ASA scores (76.1% versus 71.4% were ASA 3-4, P < 0.001). PM had more malignancy (83.0% versus 73.0%, P < 0.001), neoadjuvant therapy (37.7% versus 28.8%, P < 0.001), total lobectomy (30.6% versus 23.2%, P < 0.001), open resection (90.8% versus 74.9%, P < 0.001), and longer operations (246 min versus 212 min, P < 0.001). PM was associated with longer LOS (0.36 d, 95% confidence interval [CI] 0.11-0.60) and increased risk of PHLF (odds ratio [OR] 1.36, 95% CI 1.11-1.66), although not clinically significant grade B/C PHLF (OR 0.82, 95% CI 0.57-1.19), but was not associated with receipt of perioperative blood transfusions (OR 1.00, 95% CI 0.69-1.64). Conclusions: PM is associated with similar clinically significant PHLF and transfusion requirements but longer LOS compared with no Pringle maneuver.

Original languageEnglish (US)
Pages (from-to)253-260
Number of pages8
JournalJournal of Surgical Research
Volume239
DOIs
StatePublished - Jul 1 2019

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Liver Failure
Length of Stay
Confidence Intervals
Liver
Odds Ratio
Hepatectomy
Blood Transfusion
Neoadjuvant Therapy
Quality Improvement
Blood Vessels
Databases
Neoplasms

Keywords

  • Hepatectomy
  • Inflow vascular occlusion
  • Liver resection
  • Pringle maneuver
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

@article{749bbb4bf7044406ab589368a31afae4,
title = "Current Pattern of Use and Impact of Pringle Maneuver in Liver Resections in the United States",
abstract = "Background: Pringle maneuver (PM) is used for inflow vascular control during hepatectomy, but its use remains controversial. We aimed to report its pattern of use and association with postoperative outcomes. Methods: We identified hepatectomy patients using the liver-targeted National Surgical Quality Improvement Program database (2014-2016). Associations between PM and posthepatectomy liver failure (PHLF), receipt of blood transfusion, and total hospital length of stay (LOS) were evaluated. Results: We identified 7870 patients (74.9{\%}) with no Pringle maneuver and 2632 (25.1{\%}) with PM. PM patients were older (median age 61 versus 60 y, P = 0.002) and had higher ASA scores (76.1{\%} versus 71.4{\%} were ASA 3-4, P < 0.001). PM had more malignancy (83.0{\%} versus 73.0{\%}, P < 0.001), neoadjuvant therapy (37.7{\%} versus 28.8{\%}, P < 0.001), total lobectomy (30.6{\%} versus 23.2{\%}, P < 0.001), open resection (90.8{\%} versus 74.9{\%}, P < 0.001), and longer operations (246 min versus 212 min, P < 0.001). PM was associated with longer LOS (0.36 d, 95{\%} confidence interval [CI] 0.11-0.60) and increased risk of PHLF (odds ratio [OR] 1.36, 95{\%} CI 1.11-1.66), although not clinically significant grade B/C PHLF (OR 0.82, 95{\%} CI 0.57-1.19), but was not associated with receipt of perioperative blood transfusions (OR 1.00, 95{\%} CI 0.69-1.64). Conclusions: PM is associated with similar clinically significant PHLF and transfusion requirements but longer LOS compared with no Pringle maneuver.",
keywords = "Hepatectomy, Inflow vascular occlusion, Liver resection, Pringle maneuver, Surgical outcomes",
author = "Hester, {Caitlin A.} and {El Mokdad}, Ali and Mansour, {John C.} and Porembka, {Matthew R.} and Yopp, {Adam C.} and Zeh, {Herbert J.} and Polanco, {Patricio M.}",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.jss.2019.01.043",
language = "English (US)",
volume = "239",
pages = "253--260",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Current Pattern of Use and Impact of Pringle Maneuver in Liver Resections in the United States

AU - Hester, Caitlin A.

AU - El Mokdad, Ali

AU - Mansour, John C.

AU - Porembka, Matthew R.

AU - Yopp, Adam C.

AU - Zeh, Herbert J.

AU - Polanco, Patricio M.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Pringle maneuver (PM) is used for inflow vascular control during hepatectomy, but its use remains controversial. We aimed to report its pattern of use and association with postoperative outcomes. Methods: We identified hepatectomy patients using the liver-targeted National Surgical Quality Improvement Program database (2014-2016). Associations between PM and posthepatectomy liver failure (PHLF), receipt of blood transfusion, and total hospital length of stay (LOS) were evaluated. Results: We identified 7870 patients (74.9%) with no Pringle maneuver and 2632 (25.1%) with PM. PM patients were older (median age 61 versus 60 y, P = 0.002) and had higher ASA scores (76.1% versus 71.4% were ASA 3-4, P < 0.001). PM had more malignancy (83.0% versus 73.0%, P < 0.001), neoadjuvant therapy (37.7% versus 28.8%, P < 0.001), total lobectomy (30.6% versus 23.2%, P < 0.001), open resection (90.8% versus 74.9%, P < 0.001), and longer operations (246 min versus 212 min, P < 0.001). PM was associated with longer LOS (0.36 d, 95% confidence interval [CI] 0.11-0.60) and increased risk of PHLF (odds ratio [OR] 1.36, 95% CI 1.11-1.66), although not clinically significant grade B/C PHLF (OR 0.82, 95% CI 0.57-1.19), but was not associated with receipt of perioperative blood transfusions (OR 1.00, 95% CI 0.69-1.64). Conclusions: PM is associated with similar clinically significant PHLF and transfusion requirements but longer LOS compared with no Pringle maneuver.

AB - Background: Pringle maneuver (PM) is used for inflow vascular control during hepatectomy, but its use remains controversial. We aimed to report its pattern of use and association with postoperative outcomes. Methods: We identified hepatectomy patients using the liver-targeted National Surgical Quality Improvement Program database (2014-2016). Associations between PM and posthepatectomy liver failure (PHLF), receipt of blood transfusion, and total hospital length of stay (LOS) were evaluated. Results: We identified 7870 patients (74.9%) with no Pringle maneuver and 2632 (25.1%) with PM. PM patients were older (median age 61 versus 60 y, P = 0.002) and had higher ASA scores (76.1% versus 71.4% were ASA 3-4, P < 0.001). PM had more malignancy (83.0% versus 73.0%, P < 0.001), neoadjuvant therapy (37.7% versus 28.8%, P < 0.001), total lobectomy (30.6% versus 23.2%, P < 0.001), open resection (90.8% versus 74.9%, P < 0.001), and longer operations (246 min versus 212 min, P < 0.001). PM was associated with longer LOS (0.36 d, 95% confidence interval [CI] 0.11-0.60) and increased risk of PHLF (odds ratio [OR] 1.36, 95% CI 1.11-1.66), although not clinically significant grade B/C PHLF (OR 0.82, 95% CI 0.57-1.19), but was not associated with receipt of perioperative blood transfusions (OR 1.00, 95% CI 0.69-1.64). Conclusions: PM is associated with similar clinically significant PHLF and transfusion requirements but longer LOS compared with no Pringle maneuver.

KW - Hepatectomy

KW - Inflow vascular occlusion

KW - Liver resection

KW - Pringle maneuver

KW - Surgical outcomes

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U2 - 10.1016/j.jss.2019.01.043

DO - 10.1016/j.jss.2019.01.043

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C2 - 30856518

AN - SCOPUS:85062472519

VL - 239

SP - 253

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JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

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