Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection
Despite technical advances, bile leak remains a significant complication after hepatectomy. The current study uses a targeted multi-institutional dataset to characterize perioperative factors that are associated with bile leakage after hepatectomy to better understand the impact of bile leak on morbidity and mortality.
Adult patients in the 2014–2015 ACS NSQIP targeted hepatectomy dataset were linked to the ACS NSQIP PUF dataset. Bivariable and multivariable regression analyses were used to assess the associations between clinical factors and post-hepatectomy bile leak.
Of 6859 patients, 530 (7.7%) had a postoperative bile leak. Proportion of bile leaks was significantly greater in patients after major compared to minor hepatectomy (12.6 vs. 5.1%, p < 0.001). The proportion of patients with bile leak was significantly greater in patients after major hepatectomy who had concomitant enterohepatic reconstruction (31.8 vs. 10.1%, p < 0.001). Postoperative mortality was significantly greater in patients with bile leaks (6.0 vs. 1.7%, p < 0.001). After adjusting for significant covariates, bile leak was independently associated with increased risk of postoperative morbidity (OR = 4.55; 95% CI 3.72–5.56; p < 0.001). After adjusting for significant effects of postoperative complications, liver failure, and reoperation (all p<0.001), bile leak was not independently associated with increased risk of postoperative mortality (p = 0.262).
Major hepatectomy and enterohepatic biliary reconstruction are associated with significantly greater rates of bile leak after liver resection. Bile leak is independently associated with significant postoperative morbidity. Mitigation of bile leak is critical in reducing morbidity and mortality after liver resection.
KeywordsBile leak Hepatectomy Liver resection Major hepatectomy Biliary complication Drain Morbidity and mortality
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. This study was supported in part by funding support provided by the Institutional National Research Service Award T32 CA 163177 from the National Cancer Institute to ANM and Loan Repayment Program Award 1 L30 CA220861-01 from the National Cancer Institute to VMZ.
Conception and design of study: Martin, Stukenborg, Zaydfudim.
Acquisition of data: Martin, Narayanan, Turrentine.
Analysis and/or interpretation of data: Martin, Narayanan, Turrentine, Bauer, Adams, Stukenborg, Zaydfudim.
Drafting the manuscript: Martin, Narayanan, Turrentine.
Revising the manuscript critically for important intellectual content: Bauer, Adams, Stukenborg, Zaydfudim.
Final approval of the version of the manuscript to be published: Martin, Narayanan, Turrentine, Bauer, Adams, Zaydfudim.
G. Stukenborg significantly contributed to the entire project including manuscript composition and revision prior to his sudden and untimely death at the end of Summer 2017.
Agreement to be accountable for all aspects of the work: Martin, Narayanan, Turrentine, Bauer, Adams, Stukenborg (posthumously), Zaydfudim.
Compliance with Ethical Standards
Nothing to disclose.
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