Utilizing risk-stratified pathways to personalize post-hepatectomy discharge planning: A contemporary analysis of 1,354 patients

Allison N Martin; Timothy E Newhook; Elsa M Arvide; Bradford J Kim; Whitney L Dewhurst; Yoshikuni Kawaguchi; Hop S Tran Cao; Yun Shin Chun; Matthew Hg Katz; Jean-Nicolas Vauthey; Ching-Wei D Tzeng

doi:10.1016/j.amjsurg.2023.12.013

Utilizing risk-stratified pathways to personalize post-hepatectomy discharge planning: A contemporary analysis of 1,354 patients

Am J Surg. 2023 Dec 15:S0002-9610(23)00659-1. doi: 10.1016/j.amjsurg.2023.12.013. Online ahead of print.

Affiliations

¹ Department of Surgery, Duke University Medical Center, Durham, NC, USA.
² Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³ Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: CDTzeng@mdanderson.org.

PMID: 38129274
DOI: 10.1016/j.amjsurg.2023.12.013

Abstract

Background: While risk-stratified post-hepatectomy pathways (RSPHPs) reduce length-of-stay, can they stratify hepatectomy patients by risk of early postoperative events.

Methods: 90-day outcomes from consecutive hepatectomies were analyzed (1/1/2017-12/31/2021). Pre/post-pathway analysis was performed for pathways: minimally invasive surgery ("MIS"); non-anatomic resection/left hepatectomy ("low-intermediate risk"); right/extended hepatectomy ("high-risk"); "Combination" operations. Time-to-event (TTE) analyses for readmission and interventional radiology procedures (IRPs) was performed.

Results: 1354 patients were included: MIS/n= 119 (9 %); low-intermediate risk/n= 443 (33 %); high-risk/n= 328 (24 %); Combination/n= 464 (34 %). There was no difference in readmission (pre: 13 % vs. post:11.5 %, p = 0.398). There were fewer readmissions in post-pathway patients amongst MIS, low-intermediate risk, and Combination patients (all p > 0.1). 114 (8.4 %) patients required IRPs. Time-to-readmission and time-to-IR-procedure plots demonstrated lower plateaus and flatter slopes for MIS/low-intermediate-risk pathways post-pathway implementation (p < 0.001).

Conclusion: RSPHPs can reliably stratify patients by risks of readmission or need for an IR procedure by predicting the most frequent period for these events.

Keywords: Enhanced recovery; Hepatobiliary surgery; Liver resection; Perioperative complications; Quality improvement; Readmission.