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Risk Factors for Complications Requiring Interventional Radiological Treatment After Hepatectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

To identify perioperative factors that are significantly associated with complications requiring interventional radiology (IR) treatment after hepatectomy.

Methods

We retrospectively reviewed data from 11,243 patients in the USA who underwent hepatectomy from 2014 to 2016 using the National Surgical Quality Improvement Program database. Data on the following IR procedures were extracted: abscess drain placement, endovascular treatment for bleeding, and postoperative percutaneous biliary drain (PBD) placement up to 30 days postoperatively. Patients’ clinical and intraoperative factors were examined. Population, univariate, and multivariable analyses were performed. P < 0.05 was considered significant.

Results

A total of 704 patients (6%) required IR treatment postoperatively, and 10,539 patients (94%) did not. On multivariable analysis, biliary reconstruction was a significant predictor of postoperative abscess drain placement (hazard ratio (HR), 3.5; 95% confidence interval (CI) 1.8, 6.5; P < .001), endovascular treatment for bleeding (HR, 3.3; 95% CI 1.4, 7.8 P = .006), and postoperative PBD placement (HR, 2.9; 95% CI 1.9, 4.2; P < .001). Compared with hepatectomy without biliary reconstruction, hepatectomy with biliary reconstruction was associated with significantly higher rates of complications treated with IR procedures (26% vs. 4.9%) and death within 30 days (6.0% vs. 1.2%) (both, P < .001).

Conclusion

Biliary reconstruction is a strong predictor of the need for postoperative IR treatment after hepatectomy. One in four patients who underwent biliary reconstruction required IR treatment of a complication during the first 30 days after hepatectomy.

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Author information

Authors and Affiliations

  1. Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Andrew R. Kolarich, Alex J. Solomon, Clifford R. Weiss & Kelvin Hong

  2. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Matthew J. Weiss & Benjamin Philosophe

  3. Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans St, Sheikh Zayed Tower, Room 7203, Baltimore, MD, 21287, USA

    Kelvin Hong

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  1. Andrew R. Kolarich
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Correspondence to Kelvin Hong.

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Conflict of Interest

Dr. Clifford Weiss reports an institutional grant from Merit Medical and Siemens Healthcare and material support from Surefire Medical, as well as institutional grant and payment received for consultancy from BTG and Medtronic. Dr. Kelvin Hong reports receipt of payment from Boston Scientific (as medical advisor) and BTG for consultancy and grants received from BTG and Merit Medical. Other authors report no conflicts of interest.

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Kolarich, A.R., Solomon, A.J., Weiss, M.J. et al. Risk Factors for Complications Requiring Interventional Radiological Treatment After Hepatectomy. J Gastrointest Surg 25, 1184–1192 (2021). https://doi.org/10.1007/s11605-020-04609-3

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  • DOI: https://doi.org/10.1007/s11605-020-04609-3

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