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Failure to Rescue in Major Hepatectomy: A Comparative Analysis Based on Operative Approach
Sara Saeidishahri
*, Amir Ebadinejad, Oscar Serrano
Department of Surgery, Hartford Hospital, Hartford, CT
Background: Failure to rescue (FTR), defined as mortality following postoperative complications, is a critical quality metric in surgical outcomes. While minimally-invasive approaches to major hepatectomy have increased, FTR rates between minimally-invasive hepatectomy (MISH) and open surgery are unknown.
Study Design: An analysis of the National Surgical Quality Improvement Program2022–2023 database identified patients undergoing major hepatectomies. FTR was calculated as the proportion of patients who died after experiencing a complication. Multivariable logistic regression adjusted for patient demographics was utilized to assess the relationship between surgical approach and FTR.
Results: A total of 9,836 patients underwent major hepatectomy (63% male, 65.7% White, 5.1% Hispanic, age of 69.1 ± 9.6 years). The most common diagnoses were hepatocellular carcinoma (16.3%), cholangiocarcinoma (8.4%) and gallbladder cancer (5.1%). MISH (laparoscopic or robotic) comprised 31.4% of the cohort (18% laparoscopic, 13.4% robotic). Postoperative complications occurred in 3,113 patients (31.6%); 137 patients (4.4%) died during the index hospitalization. The FTR rate for the open, laparoscopic, and robotic groups was 4.9%, 2.1%, and 2.6%, respectively (p<0.001). In regression analysis, adjusting for age, gender, and race, open approach had significantly higher FTR compared to MISH (p=0.002, OR: 2.41, CI: 1.36-4.24). Length of stay (LOS) for the open, laparoscopic, and robotic groups was 4.8, 2.8, and 3.2 days, respectively (p< 0.001).
Conclusion: Minimally-invasive approaches in major hepatectomy appear to yield better postoperative outcomes, with significantly lower FTR. MISH demonstrated improved LOS, calling for further investigation into its cost-effectiveness.
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