Department of Surgery, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA 30809, USA.
Department of Surgery, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA 30809, USA; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14203, USA.
Hepatobiliary Pancreat Dis Int. 2019 Oct;18(5):439-445. doi: 10.1016/j.hbpd.2019.07.002. Epub 2019 Jul 6.
Major hepatic resection, predominantly performed for oncologic intent, is a complex procedure with the potential for severe intraoperative hemorrhage. The current surgical era has the ability to improve hemostasis throughout the performance of major hepatic resections which decreases blood transfusions and the detrimental effects associated with transfusion. We evaluated hemostasis and outcomes in the current surgical era of performing hepatic resections.
Utilizing the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database all major hepatic resections performed between 2012 and 2016 were analyzed in regards to hemostasis. Hemostasis was evaluated by the need for and magnitude of blood transfusions. Additional perioperative variables (including operative time, length of hospital stay, and mortality rates) were analyzed to assess for outcomes with hemostasis. The NSQIP results were compared to previous publications involving major hepatic resections to detect improvement in hemostasis and outcomes in the current surgical era.
A total of 22777 major hepatic resections met the inclusion criteria for analysis in the NSQIP database. An additional 21198 cases were compiled within the selected publications for comparative analysis. The transfusion rate in the current surgical era was 13.3% versus 38.7% in the previous era (P = 0.0001). When a transfusion was required in the current surgical era there was a two-fold reduction in the number of units transfused (1.5 U vs. 3.8 U, P = 0.0001). Statistically significant improvements in operative time and length of hospital stay were presented within the current surgical era (P = 0.0001). When a transfusion was required there was an increased relative risk score of 7 for mortality (4.9% vs. 0.7%, P = 0.0001), however, improvement in mortality rates did not reach statistical significance across surgical eras (1.3% vs. 4.0%, P = 0.0001).
The conduction of major hepatic resection in the current surgical era is more hemostatic. Correlated with improved hemostasis are better outcomes for both clinical and financial endpoints. These findings should encourage continued and increased performance of major hepatic resections.
主要的肝切除术，主要是为了治疗肿瘤，是一种复杂的手术，有发生严重术中出血的风险。当前的手术时代能够提高肝切除术的止血能力，减少输血和输血相关的不利影响。我们评估了在当前的肝切除术时代进行肝切除术的止血效果和结果。
利用美国外科医师学院（ACS）国家外科质量改进计划（NSQIP）数据库，分析了 2012 年至 2016 年间所有主要的肝切除术在止血方面的情况。通过输血的需求和输血的量来评估止血效果。分析了其他围手术期变量（包括手术时间、住院时间和死亡率），以评估止血效果的结果。将 NSQIP 结果与涉及主要肝切除术的以前的出版物进行比较，以检测当前手术时代在止血和结果方面的改善。
共有 22777 例主要肝切除术符合 NSQIP 数据库的纳入标准。在选定的出版物中还汇编了另外 21198 例病例进行比较分析。当前手术时代的输血率为 13.3%，而前一时代为 38.7%（P=0.0001）。当前手术时代需要输血时，输血量减少了一倍（1.5U 与 3.8U，P=0.0001）。当前手术时代在手术时间和住院时间方面呈现出统计学上的显著改善（P=0.0001）。当需要输血时，死亡率的相对风险评分增加了 7 倍（4.9%比 0.7%，P=0.0001），但在不同的手术时代，死亡率的改善并未达到统计学意义（1.3%比 4.0%，P=0.0001）。
当前手术时代进行主要的肝切除术更具止血性。与改善止血相关的是更好的临床和财务结果。这些发现应该鼓励继续和增加主要肝切除术的实施。
