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Assessment of complications after liver surgery: Two novel grading systems applied to patients undergoing hepatectomy

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Summary

Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. The absence of a definition and a widely accepted ranking system to classify surgical complications has hampered proper interpretation of the surgical outcome. This study aimed to define and search the simple and reproducible classification of complications following hepatectomy based on two therapy-oriented severity grading system: Clavien-Dindo classification of surgical complications and Accordion severity grading of postoperative complications. Two classifications were tested in a cohort of 2008 patients who underwent elective liver surgery at our institution between January 1986 and December 2005. Univariate and multivariate analyses were performed to link respective complications with perioperative parameters, length of hospital stay and the quality of life. A total of 1716 (85.46%) patients did not develop any complication, while 292 (14.54%) patients had at least one complication. According to Clavien-Dindo classification of surgical complications system, grade I complications occurred in 150 patients (7.47%), grade II in 47 patients (2.34%), grade IIIa in 59 patients (2.94%), grade IIIb in 13 patients (0.65%), grade IVa in 7 patients (0.35%), grade IVb in 1 patient (0.05%), and grade V in 15 patients (0.75%). According to Accordion severity grading of postoperative complications system, mild complications occurred in 160 patients (7.97%), moderate complications in 48 patients (2.39%), severe complications (invasive procedure/no general anesthesia) in 48 patients (2.39%), severe complications (invasive procedure under general anesthesia or single organ system failure) in 20 patients (1.00%), severe complications (organ system failure and invasive procedure under general anesthesia or multisystem organ failure) in 1 patient (0.05%), and mortality was 0.75% (n=15). Complication severity of Clavien-Dindo system and Accordion system were all correlated with the length of hospital stay, the number of hepatic segments resected, the blood transfusion and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). The Clavien-Dindo classification system and Accordion classification system are the simple ways of reporting all complications following the liver surgery.

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References

  1. Andreou A, Vauthey JN, Cherqui D, et al. International Cooperative Study Group on Hepatocellular Carcinoma. Improved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomy. J Gastrointest Surg, 2013,17(1):66–77

    PubMed  Google Scholar 

  2. Jin S, Fu Q, Wuyun G, et al. Management of post-hepatectomy complications. World J Gastroenterol, 2013,19(44):7983–7991

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hardy KJ. Liver surgery: the past 2000 years. Aust N Z J Surg, 1990,60(10):811–817

    Article  CAS  PubMed  Google Scholar 

  4. Tanabe KK. The past 60 years in liver surgery. Cancer, 2008,113(7 Suppl):1888–1896

    Article  PubMed  Google Scholar 

  5. Ris F, Majno P, Morel P, et al. Complex liver resections: where are the limits? Rev Med Suisse (French), 2008,4(163):1558–1562

    CAS  Google Scholar 

  6. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg, 2006,244(6):931–937

    Article  PubMed  PubMed Central  Google Scholar 

  7. Huang ZQ, Xu LN, Yang T, et al. Hepatic resection: an analysis of the impact of operative and perioperative factors on the morbidity and mortality rate. Chin Med J, 2009,122(19):2268–2277

    PubMed  Google Scholar 

  8. Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery, 2011,149(5):680–688

    Article  PubMed  Google Scholar 

  9. Mentula PJ, Leppäniemi AK. Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients. Patient Saf Surg, 2014,8(1):31

    Article  PubMed  PubMed Central  Google Scholar 

  10. Porembka MR, Hall BL, Hirbe M, et al. Quantitative weighting of postoperative complications based on the accordion severity grading system: demonstration of potential impact using the american college of surgeons national surgical quality improvement program. J Am Coll Surg, 2010,210(3):286–298

    Article  PubMed  Google Scholar 

  11. Vollmer CM Jr, Lewis RS, Hall BL, et al. Establishing a quantitative benchmark for morbidity in pancreatoduodenectomy using ACS-NSQIP, the Accordion Severity Grading System, and the Postoperative Morbidity Index. Ann Surg, 2015,261(3):527–536

    Article  PubMed  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004,240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  13. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg, 2009,250(2):177–186

    Article  PubMed  Google Scholar 

  14. Strasberg SM, Hall BL. Postoperative morbidity index: a quantitative measure of severity of postoperative complications. J Am Coll Surg, 2011,213(5):616–626

    Article  PubMed  Google Scholar 

  15. de Vries EN, Prins HA, Crolla RM, et al. SURPASS Collaborative Group. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med, 2010,363(20):1928–1937

    PubMed  Google Scholar 

  16. Cescon M, Vetrone G, Grazi GL, et al. Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg, 2009,249(6):995–1002

    Article  PubMed  Google Scholar 

  17. Yang T, Zhang J, Lu JH, et al. Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg, 2011,35(9):2073–2082

    Article  PubMed  Google Scholar 

  18. Sajid MS, Iftikhar M, Rimple J, et al. Use of health-related quality of life tools in hepatobiliary surgery. Hepatobiliary Pancreat Dis Int, 2008,7(2):135–137

    PubMed  Google Scholar 

  19. Gandhi S, Khubchandani S, Iyer R. Quality of life and hepatocellular carcinoma. J Gastrointest Oncol, 2014,5(4):296–317

    PubMed  PubMed Central  Google Scholar 

  20. dos Santos DC, Limongi V, de Oliveira da Silva AM, et al. Evaluation of functional status, pulmonary capacity, body composition, and quality of life of end-stage liver disease patients who are candidates for liver surgery. Transplant Proc, 2014,46(6):1771–1774

    Article  PubMed  Google Scholar 

  21. Toro A, Pulvirenti E, Palermo F, et al. Health-related quality of life in patients with hepatocellular carcinoma after hepatic resection, transcatheter arterial chemoembolization, radiofrequency ablation or no treatment. Surg Oncol, 2012, 21(1):e23–e30

    Article  PubMed  Google Scholar 

  22. Kamphues C, Engel S, Denecke T, et al. Safety of liver resection and effect on quality of life in patients with benign hepatic disease: single center experience. BMC Surg, 2011,11:16

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bruns H, Krätschmer K, Hinz U, et al. Quality of life after curative liver resection: a single center analysis. World J Gastroenterol 2010,16(19):2388–2395

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pritchard MJ. Using the hospital anxiety and depression scale in surgical patients. Nurs Stand, 2011,25(34):35–41

    Article  CAS  Google Scholar 

  25. Fong TC, Ho RT. Factor analyses of the Hospital Anxiety and Depression Scale: a Bayesian structural equation modeling approach. Qual Life Res, 2013,22(10):2857–2863

    Article  PubMed  Google Scholar 

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Acknowledgements

We are deeply grateful to Ai-qun LI, Chong-hui LI, Li-jie GAO, Guang YANG, Zhen-yu ZHU, Han-sheng LIU, and Can-hong XIANG for their help in data collection.

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Authors and Affiliations

  1. Department of General Surgery, Clinical Division of South Building, Chinese PLA General Hospital, Beijing, 100853, China

    Li-ning Xu  (徐立宁) & De-wei Gao  (高德伟)

  2. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Bo Yang  (杨 波)

  3. Department of Radiology, Hubei Integrated Hospital of Chinese and Western Medicine, Wuhan, 430015, China

    Gui-ping Li  (黎桂平)

Authors
  1. Li-ning Xu  (徐立宁)
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  2. Bo Yang  (杨 波)
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  3. Gui-ping Li  (黎桂平)
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  4. De-wei Gao  (高德伟)
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Corresponding authors

Correspondence to Bo Yang  (杨 波) or De-wei Gao  (高德伟).

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The authors contributed equally to this work.

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Xu, Ln., Yang, B., Li, Gp. et al. Assessment of complications after liver surgery: Two novel grading systems applied to patients undergoing hepatectomy. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 37, 352–356 (2017). https://doi.org/10.1007/s11596-017-1739-3

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  • DOI: https://doi.org/10.1007/s11596-017-1739-3

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