Failure to Rescue After Resection of Perhilar Cholangiocarcinoma in an International Multicenter Cohort.

Journal

Annals of surgical oncology

ISSN: 1534-4681

Titre abrégé: Ann Surg Oncol

Pays: United States

ID NLM: 9420840

Informations de publication

Date de publication:
15 Oct 2024

Historique:

received: 29 07 2024

accepted: 17 09 2024

medline: 15 10 2024

pubmed: 15 10 2024

entrez: 15 10 2024

Statut: aheadofprint

Résumé

Failure to rescue (FTR) is defined as the inability to prevent death after the development of a complication. FTR is a parameter in evaluating multidisciplinary postoperative complication management. The aim of this study was to evaluate FTR rates after major liver resection for perihilar cholangiocarcinoma (pCCA) and analyze factors associated with FTR. Patients who underwent major liver resection for pCCA at 27 centers were included. FTR was defined as the presence of a Dindo grade III or higher complication followed by death within 90 days after surgery. Liver failure ISGLS grade B/C were scored. Multivariable logistic analysis was performed to identify predictors of FTR and reported using odds ratio and 95% confidence intervals. In the 2186 included patients, major morbidity rate was 49%, 90-day mortality rate 13%, and FTR occurred in 24% of patients with a grade III or higher complication. Across centers, major complication rate varied from 19 to 87%, 90-day mortality rate from 5 to 33%, and FTR ranged from 11 to 50% across hospitals. Age [1.04 (1.02-1.05) years], ASA 3 or 4 [1.40 (1.01-1.95)], jaundice at presentation [1.79 (1.16-2.76)], right-sided resection [1.45 (1.06-1.98)], and annual hospital volume < 6 [1.44 (1.07-1.94)] were positively associated with FTR. When liver failure is included, the odds ratio for FTR is 9.58 (6.76-13.68). FTR occurred in 24% of patients after resection for pCCA. Liver failure was associated with a nine-fold increase of FTR and hospital volume below six was also associated with an increased risk of FTR.

Sections du résumé

BACKGROUND BACKGROUND

PATIENTS AND METHOD METHODS

Patients who underwent major liver resection for pCCA at 27 centers were included. FTR was defined as the presence of a Dindo grade III or higher complication followed by death within 90 days after surgery. Liver failure ISGLS grade B/C were scored. Multivariable logistic analysis was performed to identify predictors of FTR and reported using odds ratio and 95% confidence intervals.

RESULTS RESULTS

In the 2186 included patients, major morbidity rate was 49%, 90-day mortality rate 13%, and FTR occurred in 24% of patients with a grade III or higher complication. Across centers, major complication rate varied from 19 to 87%, 90-day mortality rate from 5 to 33%, and FTR ranged from 11 to 50% across hospitals. Age [1.04 (1.02-1.05) years], ASA 3 or 4 [1.40 (1.01-1.95)], jaundice at presentation [1.79 (1.16-2.76)], right-sided resection [1.45 (1.06-1.98)], and annual hospital volume < 6 [1.44 (1.07-1.94)] were positively associated with FTR. When liver failure is included, the odds ratio for FTR is 9.58 (6.76-13.68).

CONCLUSION CONCLUSIONS

FTR occurred in 24% of patients after resection for pCCA. Liver failure was associated with a nine-fold increase of FTR and hospital volume below six was also associated with an increased risk of FTR.

Identifiants

DOI: 10.1245/s10434-024-16293-7 PMID: 39404989

pubmed: 39404989

doi: 10.1245/s10434-024-16293-7

pii: 10.1245/s10434-024-16293-7

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Investigateurs

F Bartlett Dm Bartsch (F)

W O Bechstein (WO)

J Bednarsch (J)

C Benzing (C)

M T de Boer (MT)

S Buettner (S)

I Capobianco (I)

M I D'Angelica (MI)

P de Reuver (P)

E de Savornin Lohman (E)

C Dopazo (C)

M Efanov (M)

J I Erdmann (JI)

L C Franken (LC)

J Geers (J)

M C Giglio (MC)

S Gilg (S)

C Gomez-Gavara (C)

A Guglielmi (A)

T M van Gulik (TM)

A Hakeem (A)

J Heil (J)

H Jansson (H)

T P Kingham (TP)

S K Maithel (SK)

R Margies (R)

R Marino (R)

Q I Molenaar (QI)

T A Nguyen (TA)

L E Nooijen (LE)

C L M Nota (CLM)

E Poletto (E)

R J Porte (RJ)

R Prasad (R)

L M Quinn (LM)

F Ratti (F)

M Ravaioli (M)

J Rolinger (J)

M Schmelzle (M)

M Serenari (M)

A Sultana (A)

R Sutcliff (R)

H Topal (H)

S van Laarhoven (S)

B M Zonderhuis (BM)

Informations de copyright

Références

Valle JW, Kelley RK, Nervi B, Oh DY, Zhu AX. Biliary tract cancer. Lancet. 2021;397(10272):428–44. https://doi.org/10.1016/S0140-6736(21)00153-7 .

doi: 10.1016/S0140-6736(21)00153-7 pubmed: 33516341

Franken LC, Schreuder AM, Roos E, et al. Morbidity and mortality after major liver resection in patients with perihilar cholangiocarcinoma: A systematic review and meta-analysis. Surgery. 2019;165(5):918–28. https://doi.org/10.1016/j.surg.2019.01.010 .

doi: 10.1016/j.surg.2019.01.010 pubmed: 30871811

Hoshijima H, Wajima Z, Nagasaka H, Shiga T. Association of hospital and surgeon volume with mortality following major surgical procedures: Meta-analysis of meta-analyses of observational studies. Medicine (Baltimore). 2019;98(44):e17712. https://doi.org/10.1097/MD.0000000000017712 .

doi: 10.1097/MD.0000000000017712 pubmed: 31689806 pmcid: 6946306

Giwa F, Salami A, Abioye AI. Hospital esophagectomy volume and postoperative length of stay: A systematic review and meta-analysis. Am J Surg. 2018;215(1):155–62. https://doi.org/10.1016/j.amjsurg.2017.03.022 .

doi: 10.1016/j.amjsurg.2017.03.022 pubmed: 28343611

van Rijssen LB, Zwart MJ, van Dieren S, et al. Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit. HPB (Oxford). 2018;20(8):759–67. https://doi.org/10.1016/j.hpb.2018.02.640 .

doi: 10.1016/j.hpb.2018.02.640 pubmed: 29571615

Burke JR, Downey C, Almoudaris AM. Failure to Rescue Deteriorating Patients: A Systematic Review of Root Causes and Improvement Strategies. J Patient Saf. 2022;18(1):e140–55. https://doi.org/10.1097/PTS.0000000000000720 .

doi: 10.1097/PTS.0000000000000720 pubmed: 32453105

Elfrink AKE, Olthof PB, Swijnenburg RJ, et al. Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study. HPB (Oxford). 2021;23(12):1837–48. https://doi.org/10.1016/j.hpb.2021.04.020 .

doi: 10.1016/j.hpb.2021.04.020 pubmed: 34090804

Benzing C, Schmelzle M, Atik CF, et al. Factors associated with failure to rescue after major hepatectomy for perihilar cholangiocarcinoma: A 15-year single-center experience. Surgery. 2022;171(4):859–66. https://doi.org/10.1016/j.surg.2021.08.057 .

doi: 10.1016/j.surg.2021.08.057 pubmed: 35123795

Johnston MJ, Arora S, King D, et al. A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery. Surgery. 2015;157(4):752–63. https://doi.org/10.1016/j.surg.2014.10.017 .

doi: 10.1016/j.surg.2014.10.017 pubmed: 25794627

van Keulen AM, Buettner S, Besselink MG, et al. Surgical morbidity in the first year after resection for perihilar cholangiocarcinoma. HPB (Oxford). 2021;23(10):1607–14. https://doi.org/10.1016/j.hpb.2021.03.016 .

doi: 10.1016/j.hpb.2021.03.016 pubmed: 33947606

Bismuth H. Revisiting liver anatomy and terminology of hepatectomies. Ann Surg. 2013;257(3):383–6. https://doi.org/10.1097/SLA.0b013e31827f171f .

doi: 10.1097/SLA.0b013e31827f171f pubmed: 23386236

Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–24. https://doi.org/10.1016/j.surg.2010.10.001 .

doi: 10.1016/j.surg.2010.10.001 pubmed: 21236455

Rahbari NN, Garden OJ, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford). 2011;13(8):528–35. https://doi.org/10.1111/j.1477-2574.2011.00319.x .

doi: 10.1111/j.1477-2574.2011.00319.x pubmed: 21762295 pmcid: 3163274

Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149(5):680–8. https://doi.org/10.1016/j.surg.2010.12.002 .

doi: 10.1016/j.surg.2010.12.002 pubmed: 21316725

Portuondo JI, Shah SR, Singh H, Massarweh NN. Failure to rescue as a surgical quality indicator: current concepts and future directions for improving surgical outcomes. Anesthesiology. 2019;131(2):426–37. https://doi.org/10.1097/ALN.0000000000002602 .

doi: 10.1097/ALN.0000000000002602 pubmed: 30860985

Rosero EB, Romito BT, Joshi GP. Failure to rescue: A quality indicator for postoperative care. Best Pract Res Clin Anaesthesiol. 2021;35(4):575–89. https://doi.org/10.1016/j.bpa.2020.09.003 .

doi: 10.1016/j.bpa.2020.09.003 pubmed: 34801219

Fry BT, Smith ME, Thumma JR, Ghaferi AA, Dimick JB. Ten-year trends in surgical mortality, complications, and failure to rescue in medicare beneficiaries. Ann Surg. 2020;271(5):855–61. https://doi.org/10.1097/SLA.0000000000003193 .

doi: 10.1097/SLA.0000000000003193 pubmed: 31306158

Rosero EB, Modrall JG, Joshi GP. Failure to rescue after major abdominal surgery: The role of hospital safety net burden. Am J Surg. 2020;220(4):1023–30. https://doi.org/10.1016/j.amjsurg.2020.03.014 .

doi: 10.1016/j.amjsurg.2020.03.014 pubmed: 32199603

Smits FJ, Henry AC, Besselink MG, et al. Algorithm-based care versus usual care for the early recognition and management of complications after pancreatic resection in the Netherlands: an open-label, nationwide, stepped-wedge cluster-randomised trial. Lancet. 2022;399(10338):1867–75. https://doi.org/10.1016/S0140-6736(22)00182-9 .

doi: 10.1016/S0140-6736(22)00182-9 pubmed: 35490691

Ratti F, Cipriani F, Piozzi G, Catena M, Paganelli M, Aldrighetti L. Comparative analysis of left- versus right-sided resection in Klatskin tumor surgery: can lesion side be considered a prognostic factor? J Gastrointest Surg. 2015;19(7):1324–33. https://doi.org/10.1007/s11605-015-2840-1 .

doi: 10.1007/s11605-015-2840-1 pubmed: 25952531

Sparrelid E, Olthof PB, Dasari BV, Erdmann JI, Santol J, Starlinger P, Gilg S. Current evidence on posthepatectomy liver failure: comprehensive review. BJS open. 2022;6(6):zrac142. https://doi.org/10.1093/bjsopen/zrac142 .

doi: 10.1093/bjsopen/zrac142 pubmed: 36415029 pmcid: 9681670

Higuchi R, Yamamoto M. Indications for portal vein embolization in Perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2014;21(8):542–9. https://doi.org/10.1002/jhbp.77 .

doi: 10.1002/jhbp.77 pubmed: 24520045

Franken LC, Rassam F, van Lienden KP, et al. Effect of structured use of preoperative portal vein embolization on outcomes after liver resection of perihilar cholangiocarcinoma. BJS Open. 2020;4(3):449–55. https://doi.org/10.1002/bjs5.50273 .

doi: 10.1002/bjs5.50273 pubmed: 32181590 pmcid: 7260406

Primavesi F, Maglione M, Cipriani F, et al. E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy. Br J Surg. 2023;110(10):1331–47. https://doi.org/10.1093/bjs/znad233 .

doi: 10.1093/bjs/znad233 pubmed: 37572099 pmcid: 10480040

van Keulen AM, Buettner S, Besselink MG, et al. Primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma. Surgery. 2021;170(4):1024–30. https://doi.org/10.1016/j.surg.2021.04.013 .

doi: 10.1016/j.surg.2021.04.013 pubmed: 34020794

Buettner S, Gani F, Amini N, et al. The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer. Surgery. 2016;159(4):1004–12. https://doi.org/10.1016/j.surg.2015.10.025 .

doi: 10.1016/j.surg.2015.10.025 pubmed: 26652859

Spolverato G, Ejaz A, Hyder O, Kim Y, Pawlik TM. Failure to rescue as a source of variation in hospital mortality after hepatic surgery. Br J Surg. 2014;101(7):836–46. https://doi.org/10.1002/bjs.9492 .

doi: 10.1002/bjs.9492 pubmed: 24760705

Ardito F, Famularo S, Aldrighetti L, Grazi GL, DallaValle R, Maestri M, Jovine E, Ruzzenente A, Baiocchi GL, Ercolani G, Griseri G. The impact of hospital volume on failure to rescue after liver resection for hepatocellular carcinoma: analysis from the HE.RC.O.LE.S. Italian Registry. Ann Surg. 2020;272(5):840–6. https://doi.org/10.1097/SLA.00000000000043274 .

doi: 10.1097/SLA.00000000000043274 pubmed: 32889868

Chen Q, Olsen G, Bagante F, et al. Procedure-specific volume and nurse-to-patient ratio: implications for failure to rescue patients following liver surgery. World J Surg. 2019;43(3):910–9. https://doi.org/10.1007/s00268-018-4859-4 .

doi: 10.1007/s00268-018-4859-4 pubmed: 30465087

Blechacz B, Komuta M, Roskams T, Gores GJ. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol. 2011;8(9):512–22. https://doi.org/10.1038/nrgastro.2011.131 .

doi: 10.1038/nrgastro.2011.131 pubmed: 21808282 pmcid: 3331791

Keulen AV, Gaspersz MP, van Vugt JLA, et al. Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma. Surgery. 2022;172(6):1606–13. https://doi.org/10.1016/j.surg.2022.06.028 .

doi: 10.1016/j.surg.2022.06.028 pubmed: 35989132

Olthof PB, Wiggers JK, Groot Koerkamp B, et al. Postoperative liver failure risk score: identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein embolization. J Am Coll Surg. 2017;225(3):387–94. https://doi.org/10.1016/j.jamcollsurg.2017.06.007 .

doi: 10.1016/j.jamcollsurg.2017.06.007 pubmed: 28687509

Ribero D, Zimmitti G, Aloia TA, et al. Preoperative cholangitis and future liver remnant volume determine the risk of liver failure in patients undergoing resection for hilar cholangiocarcinoma. J Am Coll Surg. 2016;223(1):87–97. https://doi.org/10.1016/j.jamcollsurg.2016.01.060 .

doi: 10.1016/j.jamcollsurg.2016.01.060 pubmed: 27049784 pmcid: 4925184

Krautz C, Gall C, Gefeller O, Nimptsch U, Mansky T, Brunner M, Weber GF, Grützmann R, Kersting S. In-hospital mortality and failure to rescue following hepatobiliary surgery in Germany-a nationwide analysis. BMC surgery. 2020;20:1–1. https://doi.org/10.1186/s12893-020-00817-5 .

doi: 10.1186/s12893-020-00817-5

Sheetz KH, Nuliyalu U, Nathan H, Sonnenday CJ. Association of surgeon case numbers of pancreaticoduodenectomies vs related procedures with patient outcomes to inform volume-based credentialing. JAMA Netw Open. 2020;3(4):e203850. https://doi.org/10.1001/jamanetworkopen.2020.3850 .

doi: 10.1001/jamanetworkopen.2020.3850 pubmed: 32347950 pmcid: 7191322

Wiggers JK, Koerkamp BG, Cieslak KP, Doussot A, van Klaveren D, Allen PJ, Besselink MG, Busch OR, D’Angelica MI, DeMatteo RP, Gouma DJ. Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant. J Am Coll Surg. 2016;223(2):321–31. https://doi.org/10.1016/j.jamcollsurg.2016.03.035 .

doi: 10.1016/j.jamcollsurg.2016.03.035 pubmed: 27063572 pmcid: 4961586