Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
J Gastrointest Surg. 2022 Feb;26(2):314-322. doi: 10.1007/s11605-021-05088-w. Epub 2021 Aug 6.
The effect of varying severity and timing of complications after hepatic resection on 30-day mortality has not been thoroughly examined.
National Surgical Quality Improvement Program Patient User Files (NSQIP-PUF) were used to identify patients who underwent elective hepatic resection between 2014 and 2019. The impact of number, timing, and severity of complications on 30-day mortality was examined.
Among 25,084 patients who underwent hepatic resection, 7436 (29.9%) patients developed at least one NSQIP complication, while 2688 (10.7%) had multiple (≥2) complications. Overall, 30-day mortality was 1.7% (n=424), among whom 81.4% (n=345) patients had ≥2 complications. The 30-day mortality was highest among patients with three consecutive severe complications (47.8%), as well as patients with one non-severe and two subsequent severe complications (47.6%). The adjusted probability of 30-day mortality was 35.5% (95%CI: 29.5-41.4%) when multiple severe complications occurred within the first postoperative week and 16.2% (95%CI: 7.2-25.1%) when the second severe complication occurred at least one week apart. The adjusted risk of 30-day mortality after even two non-severe complications was as high as 5.3% (95%CI: 3.7-6.9%) when the second complication occurred within a week postoperatively.
Approximately 1 in 10 patients developed multiple complications following hepatectomy. Timing and severity of complications were independently associated with 30-day mortality.
尚未彻底研究肝切除术后并发症严重程度和时间变化对 30 天死亡率的影响。
使用国家手术质量改进计划患者用户档案（NSQIP-PUF）确定 2014 年至 2019 年间接受择期肝切除术的患者。检查并发症数量、时间和严重程度对 30 天死亡率的影响。
在接受肝切除术的 25084 例患者中，7436 例（29.9%）患者至少发生了 1 项 NSQIP 并发症，而 2688 例（10.7%）患者发生了多种（≥2 种）并发症。总体而言，30 天死亡率为 1.7%（n=424），其中 81.4%（n=345）患者有≥2 种并发症。30 天死亡率最高的是连续发生 3 种严重并发症的患者（47.8%），以及有 1 种非严重并发症和随后发生的 2 种严重并发症的患者（47.6%）。当多个严重并发症在术后第一周内连续发生时，30 天死亡率的调整概率为 35.5%（95%CI：29.5-41.4%），当第二个严重并发症相隔至少一周发生时，调整后的 30 天死亡率为 16.2%（95%CI：7.2-25.1%）。即使发生了 2 次非严重并发症，当第二次并发症发生在术后一周内时，30 天死亡率的调整风险也高达 5.3%（95%CI：3.7-6.9%）。
约每 10 例接受肝切除术的患者中就有 1 例发生了多种并发症。并发症的时间和严重程度与 30 天死亡率独立相关。
