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Individual components of post-hepatectomy care pathways have differential impacts on length of stay

Published:October 01, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.09.050

      Highlights

      • Length of stay (LOS) after hepatectomy is associated with individual components of risk stratified post-hepatectomy pathways.
      • Intraoperative factors like increased intravenous fluid volume and operative time are negatively associated with LOS.
      • Minimally invasive surgery is associated with reduced LOS, while multi-organ surgery is associated with prolonged LOS.
      • Post-hepatectomy pathways should focus on iterative changes to individual components to improve composite outcomes.

      Abstract

      Background

      The value of individual variable contributions to post-hepatectomy length of stay (LOS) are difficult to quantify within bundled care pathways.

      Methods

      Poisson regression and marginal effects models for prolonged post-hepatectomy LOS (>25% median) included Kawaguchi-Gayet (KG) complexity, perioperative variables, and pathways (minimally-invasive = MIS; low-intermediate-risk = KGI/II; high-risk = KGIII; combination).

      Results

      Median LOS was 2, 4, 5, and 5 days for MIS, KGI/II, KGIII and combination pathways (N = 978). Poisson regression identified age, intraoperative fluids, delayed diet tolerance, and combination cases as associated with increased LOS (p < 0.01). Marginal effects analysis demonstrated the following added probability of longer LOS: each year of age 0.03x, 250 mL intraoperative fluids 0.06x, each operative hour 0.2x, additional day before diet tolerance 0.4x, combination cases 0.7x. MIS was associated with 1.2x increased probability of shorter LOS.

      Conclusions

      Optimizing intraoperative fluids, operative time, and postoperative diet, while favoring MIS approach when feasible, may maximize effects of post-hepatectomy care pathways to reduce LOS.

      Keywords

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