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Impact of Preoperative Cholangitis on Short-term Outcomes Among Patients Undergoing Liver Resection

  • Kota Sahara
  • Katiuscha Merath
  • J. Madison Hyer
  • Anghela Z. Paredes
  • Diamantis I. Tsilimigras
  • Rittal Mehta
  • Syeda A. Farooq
  • Amika Moro
  • Lu Wu
  • Susan White
  • Itaru Endo
  • Timothy M. PawlikEmail author
Original Article
  • 19 Downloads

Abstract

Background

The impact of preoperative cholangitis (PC) on perioperative outcomes among patients undergoing liver resection remains poorly defined. We sought to characterize the prevalence of PC among patients undergoing hepatectomy and define the impact of PC on postoperative outcomes.

Methods

Patients who underwent liver resection 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 liver resection, stratified by the presence of PC, were examined. Subgroup analyses were performed to evaluate the relationship between the timing of liver resection relative to PC.

Results

Among 7392 patients undergoing liver resection, 251 patients (3.4%) experienced PC. Patients with PC were more likely to be male (59.0% vs. 50.6%) and to have a benign diagnosis (34.3% vs. 19.8%) compared with patients without PC (both p<0.05). On multivariable analysis, PC was associated with increased odds of experiencing a complication (OR 1.54, 95%CI 1.17–2.03), extended LOS (OR 2.60, 95%CI 1.99–3.39), 90-day mortality (OR 2.31, 95%CI 1.64–3.26), and higher Medicare expenditures (OR 3.32, 95%CI 2.55–4.32). Among patients with PC, requirement of both endoscopic and percutaneous biliary drainage (OR 5.16, 95%CI 1.36–9.61), as well as liver resection < 2 weeks after PC (OR 2.92, 95%CI 1.13–7.57) were associated with higher odds of 90-day mortality.

Conclusion

Approximately 1 in 30 Medicare beneficiaries undergoing liver resection had a history of PC. PC was associated with an increased risk of adverse short-term outcomes and higher healthcare expenditures among patients undergoing hepatectomy.

Keywords

Cholangitis Preoperative Liver resection Outcomes 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4430_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 19 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Kota Sahara
    • 1
    • 2
  • Katiuscha Merath
    • 1
  • J. Madison Hyer
    • 1
  • Anghela Z. Paredes
    • 1
  • Diamantis I. Tsilimigras
    • 1
  • Rittal Mehta
    • 1
  • Syeda A. Farooq
    • 1
  • Amika Moro
    • 1
  • Lu Wu
    • 1
  • Susan White
    • 3
  • Itaru Endo
    • 2
  • Timothy M. Pawlik
    • 1
    • 4
    Email author
  1. 1.Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Comprehensive Cancer CenterColumbusUSA
  2. 2.Gastroenterological Surgery DivisionYokohama City University School of MedicineYokohamaJapan
  3. 3.Division of Health Information Management and Systems, The Ohio State Wexner Medical CenterThe Ohio State UniversityColumbusUSA
  4. 4.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical CenterThe Ohio State UniversityColumbusUSA

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