Complication timing impacts 30-d mortality after hepatectomy

Neda Amini, Georgios A. Margonis, Yuhree Kim, Ana Wilson, Faiz Gani, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background To date, no study has specifically focused on the timing of complications after hepatectomy relative to patient outcomes. We sought to investigate the effect of complication timing on 30-d mortality. Materials and methods A total of 3064 patients who underwent hepatic resection in 2014 were identified from American College of Surgeons National Surgical Quality Improvement Program database. Cox regression analysis was performed to determine the association of complication timing with 30-d mortality. Results Median patient age was 60 y (interquartile range, 50-68). Among all patients who experienced a complication, 16.6% had only a postdischarge complication. Wound disruption (64%) and surgical site infection (58.1%) occurred frequently after discharge. Organ space surgical site infection occurred at a later time after surgery among patients who underwent minimally invasive surgery (minimally invasive surgery, 16 d versus open 10 d; P = 0.008). Among 47 (1.5%) patients who died within 30 d from surgery, 21.3% of deaths occurred postdischarge. After adjusting for competing risk factors, patients who had experienced a postdischarge complication demonstrated an increased risk of 30-d mortality (referent, predischarge, hazard ratio 2.96, 95% confidence intervals 1.07-8.17; P = 0.04). Conclusions Postdischarge complications occurred less frequently after hepatectomy than predischarge complications; however, late complications were associated with a three-fold increased risk of mortality.

Original languageEnglish (US)
Pages (from-to)495-506
Number of pages12
JournalJournal of Surgical Research
Volume203
Issue number2
DOIs
StatePublished - Jun 15 2016

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Hepatectomy
Mortality
Surgical Wound Infection
Minimally Invasive Surgical Procedures
Quality Improvement
Regression Analysis
Databases
Confidence Intervals
Liver
Wounds and Injuries

Keywords

  • Hepatectomy
  • Mortality
  • Postoperative complications
  • Reoperation

ASJC Scopus subject areas

  • Surgery

Cite this

Amini, N., Margonis, G. A., Kim, Y., Wilson, A., Gani, F., & Pawlik, T. M. (2016). Complication timing impacts 30-d mortality after hepatectomy. Journal of Surgical Research, 203(2), 495-506. https://doi.org/10.1016/j.jss.2016.04.047

Complication timing impacts 30-d mortality after hepatectomy. / Amini, Neda; Margonis, Georgios A.; Kim, Yuhree; Wilson, Ana; Gani, Faiz; Pawlik, Timothy M.

In: Journal of Surgical Research, Vol. 203, No. 2, 15.06.2016, p. 495-506.

Research output: Contribution to journalArticle

Amini, N, Margonis, GA, Kim, Y, Wilson, A, Gani, F & Pawlik, TM 2016, 'Complication timing impacts 30-d mortality after hepatectomy', Journal of Surgical Research, vol. 203, no. 2, pp. 495-506. https://doi.org/10.1016/j.jss.2016.04.047
Amini N, Margonis GA, Kim Y, Wilson A, Gani F, Pawlik TM. Complication timing impacts 30-d mortality after hepatectomy. Journal of Surgical Research. 2016 Jun 15;203(2):495-506. https://doi.org/10.1016/j.jss.2016.04.047
Amini, Neda ; Margonis, Georgios A. ; Kim, Yuhree ; Wilson, Ana ; Gani, Faiz ; Pawlik, Timothy M. / Complication timing impacts 30-d mortality after hepatectomy. In: Journal of Surgical Research. 2016 ; Vol. 203, No. 2. pp. 495-506.
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