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Impact of Liver Cirrhosis on Perioperative Outcomes Among Elderly Patients Undergoing Hepatectomy: the Effect of Minimally Invasive Surgery

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The impact of cirrhosis on perioperative outcomes for elderly patients undergoing hepatectomy remains not well defined. We sought to determine the influence of underlying cirrhosis and minimally invasive surgery (MIS) on postoperative outcomes among elderly patients who underwent a hepatectomy.

Methods

Patients who underwent hepatectomy between 2013 and 2015 were identified using the Center for Medicare Services (CMS) 100% Limited Data Set (LDS) Standard Analytic Files (SAFs). Short-term outcomes after hepatectomy, stratified by the presence of cirrhosis and MIS, were examined.

Results

Among 7452 patients who underwent a hepatectomy, a minority had cirrhosis (n = 481, 6.5%) whereas the vast majority did not (n = 6971, 93.5%). Overall, median patient age was 72 years (IQR 68–76) and preoperative Charlson comorbidity score was 6 (IQR 2–8). Patients with cirrhosis were more likely to be younger (median age 71 [67–76] vs 72 [IQR 68–76] years), male (64.4% vs 50%), African American (8.1% vs 6.4%) and have a malignant diagnosis (87.1% vs 78.7%) compared to non-cirrhotic patients (all p < 0.001). There was no difference among patients with and without cirrhosis regarding type of hepatectomy or surgical approach (open vs MIS) (both p > 0.05). Patients with versus without cirrhosis had similar complication rates (24.1% vs 22.3%, p = 0.36), as well as 30-day (6.2% vs 5%, p = 0.25) and 90-day (10.4% vs 8.5%, p = 0.15) mortality. MIS reduced the length-of-stay in non-cirrhotic patients (OR 0.79, 95% CI 0.62–0.99, p < 0.05), yet was not associated with morbidity or mortality (both p > 0.05).

Conclusion

The presence of cirrhosis did not generally impact outcomes in elderly patients undergoing hepatectomy for benign and malignant diseases. MIS hepatectomy in the elderly Medicare beneficiary population reduced LOS among patients without cirrhosis, yet was not associated with differences in morbidity or mortality.

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Authors and Affiliations

  1. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Kota Sahara, Anghela Z. Paredes, Diamantis I. Tsilimigras, J. Madison Hyer, Katiuscha Merath, Lu Wu, Rittal Mehta, Eliza W. Beal & Timothy M. Pawlik

  2. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan

    Kota Sahara & Itaru Endo

  3. Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Susan White

  4. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Timothy M. Pawlik

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  1. Kota Sahara
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Sahara, K., Paredes, A.Z., Tsilimigras, D.I. et al. Impact of Liver Cirrhosis on Perioperative Outcomes Among Elderly Patients Undergoing Hepatectomy: the Effect of Minimally Invasive Surgery. J Gastrointest Surg 23, 2346–2353 (2019). https://doi.org/10.1007/s11605-019-04117-z

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