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Risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection

INTRODUCTION: Laparoscopic liver resection (LLR) has expanded rapidly. Previously published studies are limited to small samples and selected patients. Comprehensive data that may significantly influence the incidence of perioperative complications and postoperative length of stay (PLOS) are lacking...

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Autores principales: Zhang, Haili, Kang, Dufu, Liu, Fei, Li, Bo, Zhang, Wei, Wei, Yonggang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Termedia Publishing House 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9511911/
https://www.ncbi.nlm.nih.gov/pubmed/36187053
http://dx.doi.org/10.5114/wiitm.2022.118104
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author Zhang, Haili
Kang, Dufu
Liu, Fei
Li, Bo
Zhang, Wei
Wei, Yonggang
author_facet Zhang, Haili
Kang, Dufu
Liu, Fei
Li, Bo
Zhang, Wei
Wei, Yonggang
author_sort Zhang, Haili
collection PubMed
description INTRODUCTION: Laparoscopic liver resection (LLR) has expanded rapidly. Previously published studies are limited to small samples and selected patients. Comprehensive data that may significantly influence the incidence of perioperative complications and postoperative length of stay (PLOS) are lacking. AIM: To characterize complications after LLR and to identify risk factors associated with postoperative complications and prolonged PLOS. MATERIAL AND METHODS: This study was carried out at a high-volume HPB centre and included all patients who underwent LLRs between 2015 and 2018. Postoperative complications were analysed in detail. Logistic regression was used to identify independent risk factors. The primary outcome was postoperative complications with a comprehensive complication index (CCI) ≥ 26.2. The second outcome was prolonged length of stay. RESULTS: We identified 938 patients who underwent LLR. In the full cohort, 79 (8.4%) patients experienced major complications with a CCI ≥ 26.2, with postoperative mortality in 4 (0.4%) patients. On multivariate analysis, the diagnosis of primary (OR = 8.97, 95% CI: 2.54–43.74, p = 0.001) and metastatic liver tumours (OR = 5.74, 95% CI: 1.20–30.90, p = 0.028), infectious liver disease (OR = 24.04, 95% CI: 5.30–129.53, p < 0.001), difficult liver resection (OR = 2.77, 95% CI: 1.29–6.69, p = 0.014), and intraoperative bleeding > 1000 ml (OR = 9.29, 95% CI: 3.40–26.43, p < 0.001) were independent factors that increased the odds of major complications. The median PLOS after the operation was 5 days (range: 2–35 days). Factors that independently influenced prolonged PLOS on multivariate analysis were age over 70 years, metastatic liver tumour, difficult liver resection, liver cirrhosis, and right hepatectomy. CONCLUSIONS: LLR remains safe for most liver space-occupying lesions. Several preoperative and intraoperative factors associated with the risk of complications and prolonged PLOS were identified. These factors should be considered during patient selection and perioperative management.
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spelling pubmed-95119112022-09-30 Risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection Zhang, Haili Kang, Dufu Liu, Fei Li, Bo Zhang, Wei Wei, Yonggang Wideochir Inne Tech Maloinwazyjne Original Paper INTRODUCTION: Laparoscopic liver resection (LLR) has expanded rapidly. Previously published studies are limited to small samples and selected patients. Comprehensive data that may significantly influence the incidence of perioperative complications and postoperative length of stay (PLOS) are lacking. AIM: To characterize complications after LLR and to identify risk factors associated with postoperative complications and prolonged PLOS. MATERIAL AND METHODS: This study was carried out at a high-volume HPB centre and included all patients who underwent LLRs between 2015 and 2018. Postoperative complications were analysed in detail. Logistic regression was used to identify independent risk factors. The primary outcome was postoperative complications with a comprehensive complication index (CCI) ≥ 26.2. The second outcome was prolonged length of stay. RESULTS: We identified 938 patients who underwent LLR. In the full cohort, 79 (8.4%) patients experienced major complications with a CCI ≥ 26.2, with postoperative mortality in 4 (0.4%) patients. On multivariate analysis, the diagnosis of primary (OR = 8.97, 95% CI: 2.54–43.74, p = 0.001) and metastatic liver tumours (OR = 5.74, 95% CI: 1.20–30.90, p = 0.028), infectious liver disease (OR = 24.04, 95% CI: 5.30–129.53, p < 0.001), difficult liver resection (OR = 2.77, 95% CI: 1.29–6.69, p = 0.014), and intraoperative bleeding > 1000 ml (OR = 9.29, 95% CI: 3.40–26.43, p < 0.001) were independent factors that increased the odds of major complications. The median PLOS after the operation was 5 days (range: 2–35 days). Factors that independently influenced prolonged PLOS on multivariate analysis were age over 70 years, metastatic liver tumour, difficult liver resection, liver cirrhosis, and right hepatectomy. CONCLUSIONS: LLR remains safe for most liver space-occupying lesions. Several preoperative and intraoperative factors associated with the risk of complications and prolonged PLOS were identified. These factors should be considered during patient selection and perioperative management. Termedia Publishing House 2022-07-13 2022-09 /pmc/articles/PMC9511911/ /pubmed/36187053 http://dx.doi.org/10.5114/wiitm.2022.118104 Text en Copyright: © 2022 Fundacja Videochirurgii https://creativecommons.org/licenses/by-nc-sa/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
spellingShingle Original Paper
Zhang, Haili
Kang, Dufu
Liu, Fei
Li, Bo
Zhang, Wei
Wei, Yonggang
Risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection
title Risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection
title_full Risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection
title_fullStr Risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection
title_full_unstemmed Risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection
title_short Risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection
title_sort risk factors associated with postoperative complications and prolonged postoperative length of stay after laparoscopic liver resection
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9511911/
https://www.ncbi.nlm.nih.gov/pubmed/36187053
http://dx.doi.org/10.5114/wiitm.2022.118104
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