The impact of minimally invasive surgery and frailty on post-hepatectomy outcomes |
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| Affiliation: | 1. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA;2. Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA;3. Department of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, TX, USA;4. Department of Medical Oncology, Texas Tech University Health Sciences Center, El Paso, TX, USA;1. Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;2. Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;1. Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy;2. Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden;1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan;2. Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan;3. Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan;4. Division of Pathology, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan;1. General Surgery Unit, Vimercate Hospital - ASST Brianza, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy;2. Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122, Foggia, Italy;3. Unit of Digestive Surgery, University of Paris Est, UPEC, Créteil, France;1. Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France;2. University of Rennes, Rennes, France;3. INSERM U1242, Chemistry Oncogenesis Stress Signaling, Université de Rennes 1, Rennes, France;4. Service D''urologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France;5. Service des Maladies Du Foie, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France |
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| Abstract: | BackgroundThe impact of patient frailty on post-hepatectomy outcomes is not well studied. We hypothesized that patient frailty is a strong predictor of 30-day post-hepatectomy complications.MethodsThe liver-targeted National Surgical Quality Improvement Program (NSQIP) database for 2014–2019 was reviewed. A validated modified frailty index (mFI) was used.ResultsA total of 24,150 hepatectomies were reviewed. Worsening frailty was associated with increased incidence of Clavien-Dindo grade IV complications (mFI 0, 1, 2, 3, 4 was 3.9%, 6.3%, 10%, 8.1%, 50% respectively; p < 0.001). Minimally invasive hepatectomies had a lower rate of Clavien-Dindo grade IV complications for non-frail (Laparoscopic: 1%, Robotic: 2.6%, Open: 4.6%; p < 0.001) and frail patients (Laparoscopic: 3%, Robotic: 2.3%, Open: 7.7%; p < 0.001). Frail patients experienced higher incidence of post-hepatectomy liver failure (5.4% vs 4.1% for non-frail; p < 0.001) and grade C liver failure (28% vs 21.1% for non-frail; p = 0.03). Incorporating mFI to Albumin-Bilirubin score (ALBI) improved its ability to predict Clavien-Dindo grade IV complications (AUC improved from 0.609 to 0.647; p < 0.001) and 30-day mortality (AUC improved from 0.663 to 0.72; p < 0.001).ConclusionWorsening frailty correlates with increased incidence of Clavien-Dindo grade IV complications post-hepatectomy, whereas minimally invasive approaches decrease this risk. Incorporating frailty assessment to ALBI improves its ability to predict major postoperative complications and 30-day mortality. |
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