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Unplanned Reoperation After Hepatectomy: An Analysis of Risk Factors
*Heather Lyu, *Gaurav Sharma, *Ethan Brovman, *Julius Ejiofor, *Richard D. Urman, *Jason S. Gold, Edward E. Whang
Brigham and Women's Hospital/Harvard Medical School, Boston, MA
Objectives: To identify predictors for reoperation after index hepatectomy. Design: Retrospective cohort study.
Setting: 435 U.S. hospitals participating in the ACS NSQIP.
Patients: Patients undergoing anatomic/non-anatomic hepatectomy from 2011-2013 (years for which unplanned reoperation data is available) based on CPT codes. We excluded patients with missing reoperation data and emergent indication for liver resection.
Interventions: Hepatectomy (see above).
Main Outcome Measures: Unplanned reoperation within 30 days.
Results: 343 (3.7%) of 9,195 patients required reoperation within 30 days of index hepatectomy. Calculous disease and extrahepatic biliary malignancies were associated with the highest reoperation rates (9.5% and 6.0%, respectively.) The index procedures with the highest reoperation rates were trisegmentectomy (7.3%) and right lobectomy (4.7%.) Reoperative patients had increased index operative duration (323+/-174min versus 243+/-125min,p<0.001), postoperative transfusion (57% versus 23%,p<0.001), wound complications, cardiorespiratory, renal, thromboembolic, and infectious events. While there were a variety of reasons cited for reoperation, hemorrhage was the most common indication (9.7%). Male sex, ASA class 4, and index right lobectomy or trisegmentectomy were all independent predictors of unplanned reoperation (odds ratio 1.36,p=0.007; 1.95,p=0.003; 1.56,p=0.001 and 2.46,p<0.0001, respectively). All reoperations occurred during index hospitalization and resulted in longer length of stay (19.4+/-17days versus 7.2+/-6.9days,p<0.001). Unplanned reoperation was also associated with increased 30-day readmission (32.9% versus 10.9%,p<0.001) and mortality (16.9% versus 1.9%,p<0.001).
Conclusion: Index procedural and postoperative event characteristics are risk factors for unplanned reoperation within 30 days after hepatectomy in this largest and most diverse sample to date. Further study will allow the design of interventions to prevent unplanned reoperations and to mitigate their impact on patient outcomes and hospital quality assurance metrics utilized by the Joint Commission and CMS PQRS.
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