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Timing and Severity of Postoperative Complications and Associated 30-Day Mortality Following Hepatic Resection: a National Surgical Quality Improvement Project Study

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The effect of varying severity and timing of complications after hepatic resection on 30-day mortality has not been thoroughly examined.

Methods

National Surgical Quality Improvement Program Patient User Files (NSQIP-PUF) were used to identify patients who underwent elective hepatic resection between 2014 and 2019. The impact of number, timing, and severity of complications on 30-day mortality was examined.

Results

Among 25,084 patients who underwent hepatic resection, 7436 (29.9%) patients developed at least one NSQIP complication, while 2688 (10.7%) had multiple (≥2) complications. Overall, 30-day mortality was 1.7% (n=424), among whom 81.4% (n=345) patients had ≥2 complications. The 30-day mortality was highest among patients with three consecutive severe complications (47.8%), as well as patients with one non-severe and two subsequent severe complications (47.6%). The adjusted probability of 30-day mortality was 35.5% (95%CI: 29.5–41.4%) when multiple severe complications occurred within the first postoperative week and 16.2% (95%CI: 7.2–25.1%) when the second severe complication occurred at least one week apart. The adjusted risk of 30-day mortality after even two non-severe complications was as high as 5.3% (95%CI: 3.7–6.9%) when the second complication occurred within a week postoperatively.

Conclusion

Approximately 1 in 10 patients developed multiple complications following hepatectomy. Timing and severity of complications were independently associated with 30-day mortality.

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References

  1. Brooke BS, Dominici F, Pronovost PJ, Makary MA, Schneider E, Pawlik TM. Variations in surgical outcomes associated with hospital compliance with safety practices. Surgery. 2012 May;151(5):651–9.

    Article  Google Scholar 

  2. Dimick JB, Wainess RM, Cowan JA, Upchurch GR, Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection. J Am Coll Surg. 2004 Jul;199(1):31–8.

    Article  Google Scholar 

  3. Amini N, Margonis GA, Kim Y, Wilson A, Gani F, Pawlik TM. Complication timing impacts 30-d mortality after hepatectomy. J Surg Res. 2016 Jun 15;203(2):495–506.

    Article  Google Scholar 

  4. Staiger RD, Gerns E, Castrejón Subirà M, Domenghino A, Puhan MA, Clavien P-A. Can Early Postoperative Complications Predict High Morbidity and Decrease Failure to Rescue Following Major Abdominal Surgery? Ann Surg. 2020 Nov;272(5):834–9.

    Article  Google Scholar 

  5. Raoof M, Lewis A, Goldstein L, Dumitra S, Warner SG, Singh G, et al. Timing and severity of post-discharge morbidity after hepatectomy. HPB. 2017 Apr;19(4):371–7.

    Article  Google Scholar 

  6. Dellinger EP, Hausmann SM, Bratzler DW, Johnson RM, Daniel DM, Bunt KM, et al. Hospitals collaborate to decrease surgical site infections. Am J Surg. 2005 Jul;190(1):9–15.

    Article  Google Scholar 

  7. Griffin FA. Reducing surgical complications. Jt Comm J Qual Patient Saf. 2007 Nov;33(11):660–5.

    PubMed  Google Scholar 

  8. Silber JH, Romano PS, Rosen AK, Wang Y, Even-Shoshan O, Volpp KG. Failure-to-rescue: comparing definitions to measure quality of care. Med Care. 2007 Oct;45(10):918–25.

    Article  Google Scholar 

  9. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational Levels of Hospital Nurses and Surgical Patient Mortality. JAMA J Am Med Assoc. 2003;290(12):1617–23.

    Article  CAS  Google Scholar 

  10. Ghaferi AA, Dimick JB. Variation in mortality after high-risk cancer surgery: failure to rescue. Surg Oncol Clin N Am. 2012;21(3):389–95, vii.

    Article  Google Scholar 

  11. Wakeam E, Hyder JA, Tsai TC, Lipsitz SR, Orgill DP, Finlayson SRG. Complication timing and association with mortality in the American College of Surgeons’ National Surgical Quality Improvement Program database. J Surg Res. 2015;193(1):77–87.

    Article  Google Scholar 

  12. Tevis SE, Cobian AG, Truong HP, Craven MW, Kennedy GD. Implications of Multiple Complications on the Postoperative Recovery of General Surgery Patients. Ann Surg. 2016;263(6):1213–8.

    Article  Google Scholar 

  13. Feld SI, Tevis SE, Cobian AG, Craven MW, Kennedy GD. Multiple postoperative complications: Making sense of the trajectories. Surgery. 2016;160(6):1666–74.

    Article  Google Scholar 

  14. User Guide for the 2019 ACS NSQIP Participant Use Data File (PUF) [Internet]. 2020. Available from: https://www.facs.org/-/media/files/quality-programs/nsqip/nsqip_puf_userguide_2019.ashx

  15. Gani F, Canner JK, Pawlik TM. Use of the Modified Frailty Index in the American College of Surgeons National Surgical Improvement Program Database: Highlighting the Problem of Missing Data. JAMA Surg. 2017;152(2):205–7.

    Article  Google Scholar 

  16. Gani F, Cerullo M, Amini N, Buettner S, Margonis GA, Sasaki K, et al. Frailty as a Risk Predictor of Morbidity and Mortality Following Liver Surgery. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2017;21(5):822–30.

    Article  Google Scholar 

  17. Wills BW, Sheppard ED, Smith WR, Staggers JR, Li P, Shah A, et al. Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty. Orthop Traumatol Surg Res OTSR. 2018;104(4):445–8.

    Article  CAS  Google Scholar 

  18. The Brisbane 2000 Terminology of Liver Anatomy and Resections. HPB 2000; 2:333–39. HPB. 2002;4(2):99–100.

  19. Sahara K, Paredes AZ, Merath K, Tsilimigras DI, Bagante F, Ratti F, et al. Evaluation of the ACS NSQIP Surgical Risk Calculator in Elderly Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2020;24(3):551–9.

    Article  Google Scholar 

  20. Dindo D, Demartines N, Clavien P-A. 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):205–13.

    Article  Google Scholar 

  21. Gurien LA, Ra JH, Crandall M, Kerwin AJ, Tepas JJ. Clavien-Dindo Analysis of NSQIP Data Objectively Measures Patient-Focused Quality. Am Surg. 2019;85(8):789–93.

    Article  Google Scholar 

  22. Sood A, Meyer CP, Abdollah F, Sammon JD, Sun M, Lipsitz SR, et al. Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality. Br J Surg. 2017;104(10):1372–81.

    Article  CAS  Google Scholar 

  23. Tsilimigras DI, Sahara K, Moris D, Mehta R, Paredes AZ, Ratti F, et al. Assessing Textbook Outcomes Following Liver Surgery for Primary Liver Cancer Over a 12-Year Time Period at Major Hepatobiliary Centers. Ann Surg Oncol. 2020;27(9):3318–27.

    Article  Google Scholar 

  24. Gani F, Hundt J, Makary MA, Haider AH, Zogg CK, Pawlik TM. Financial Impact of Postoperative Complication Following Hepato-Pancreatico-Biliary Surgery for Cancer. Ann Surg Oncol. 2016;23(4):1064–70.

    Article  Google Scholar 

  25. Merath K, Chen Q, Bagante F, Akgul O, Idrees JJ, Dillhoff M, et al et al. Synergistic Effects of Perioperative Complications on 30-Day Mortality Following Hepatopancreatic Surgery. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2018;22(10):1715–23.

    Article  Google Scholar 

  26. Varley PR, Geller DA, Tsung A. Factors influencing failure to rescue after pancreaticoduodenectomy: a National Surgical Quality Improvement Project Perspective. J Surg Res. 2017;214:131–9.

    Article  Google Scholar 

  27. Dindo D, Hahnloser D, Clavien P-A. Quality assessment in surgery: riding a lame horse. Ann Surg. 2010;251(4):766–71.

    Article  Google Scholar 

  28. Bruce J, Russell EM, Mollison J, Krukowski ZH. The measurement and monitoring of surgical adverse events. Health Technol Assess Winch Engl. 2001;5(22):1–194.

    CAS  Google Scholar 

  29. Lucas DJ, Haut ER, Hechenbleikner EM, Wick EC, Pawlik TM. Avoiding immortal time bias in the American College of Surgeons National Surgical Quality Improvement Program readmission measure. JAMA Surg. 2014;149(8):875–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA

    Priya Pathak MBBS, MPH, Diamantis I. Tsilimigras MD, J. Madison Hyer MS, Adrian Diaz MD, MPH & Timothy M. Pawlik MD, MPH, PhD

Authors
  1. Priya Pathak MBBS, MPH
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  2. Diamantis I. Tsilimigras MD
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  3. J. Madison Hyer MS
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  4. Adrian Diaz MD, MPH
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  5. Timothy M. Pawlik MD, MPH, PhD
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Contributions

PP, DIT, JMH, and TMP conceived of and designed this work. PP performed data analysis and drafted the manuscript. PP, DIT, JMH, AD, and TMP critically revised the manuscript, provided approval of the final version, and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Conflict of Interest

The authors declare no competing interests.

Disclosures

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.

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Supplementary Information

Supplemental Figure 1.

Chronological sequence of complications and 30-day mortality if the first complication was non-severe or severe following minor hepatic resection (a, b) or major liver resection (c, d). *denotes median (IQR) of time to each complication in days from the day of the procedure. (PNG 2055 kb)

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Pathak, ., Tsilimigras, D.I., Hyer, J.M. et al. Timing and Severity of Postoperative Complications and Associated 30-Day Mortality Following Hepatic Resection: a National Surgical Quality Improvement Project Study. J Gastrointest Surg 26, 314–322 (2022). https://doi.org/10.1007/s11605-021-05088-w

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  • DOI: https://doi.org/10.1007/s11605-021-05088-w

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