Effect of operative duration on infectious complications and mortality following hepatectomy.
Cohort Studies
Diabetes Mellitus
/ epidemiology
Female
Heart Failure
/ epidemiology
Hepatectomy
/ methods
Humans
Hypertension
/ epidemiology
Length of Stay
/ statistics & numerical data
Male
Middle Aged
Operative Time
Pneumonia
/ mortality
Pulmonary Disease, Chronic Obstructive
/ epidemiology
Retrospective Studies
Sepsis
/ mortality
Shock, Septic
/ mortality
Smoking
/ epidemiology
Surgical Wound Infection
/ mortality
United States
/ epidemiology
Journal
HPB : the official journal of the International Hepato Pancreato Biliary Association
ISSN: 1477-2574
Titre abrégé: HPB (Oxford)
Pays: England
ID NLM: 100900921
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
20
11
2018
revised:
23
04
2019
accepted:
07
05
2019
pubmed:
24
6
2019
medline:
15
7
2020
entrez:
24
6
2019
Statut:
ppublish
Résumé
To study mortality and infectious complications (IC) risk relative to operative duration in a large and contemporary cohort of patients undergoing hepatectomy. A retrospective cohort study of 21,443 patients from the National Surgical Quality Improvement Program dataset of patients who underwent liver resection from 2012 to 2016. Patients undergoing hepatectomy during the study period (N = 21,443) had a mean operative duration of 243.5 min of which 16.6% (3533) developed at least one IC. The overall 30-day mortality was 1.6%. A significant increase in mortality and IC was demonstrated from 3 h of operating time (OR: 1.99 and OR: 1.94, respectively), peaking at 8 h (OR: 7.15 and OR: 6.37, respectively). Pneumonia, sepsis/septic shock, and SSI presented high prevalence and were linked to significant mortality. After case-matching, elective hepatectomy was associated with a 4-fold increased risk of infectious complications. Operative duration was associated with a linear increased risk of mortality and IC after hepatectomy. The most critical determinants of IC were ASA class, COPD, CHF, and type of hepatectomy.
Sections du résumé
BACKGROUND
To study mortality and infectious complications (IC) risk relative to operative duration in a large and contemporary cohort of patients undergoing hepatectomy.
METHODS
A retrospective cohort study of 21,443 patients from the National Surgical Quality Improvement Program dataset of patients who underwent liver resection from 2012 to 2016.
RESULTS
Patients undergoing hepatectomy during the study period (N = 21,443) had a mean operative duration of 243.5 min of which 16.6% (3533) developed at least one IC. The overall 30-day mortality was 1.6%. A significant increase in mortality and IC was demonstrated from 3 h of operating time (OR: 1.99 and OR: 1.94, respectively), peaking at 8 h (OR: 7.15 and OR: 6.37, respectively). Pneumonia, sepsis/septic shock, and SSI presented high prevalence and were linked to significant mortality. After case-matching, elective hepatectomy was associated with a 4-fold increased risk of infectious complications.
CONCLUSIONS
Operative duration was associated with a linear increased risk of mortality and IC after hepatectomy. The most critical determinants of IC were ASA class, COPD, CHF, and type of hepatectomy.
Identifiants
pubmed: 31229489
pii: S1365-182X(19)30539-8
doi: 10.1016/j.hpb.2019.05.001
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1727-1733Informations de copyright
Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.