Journal Article

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

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

2024

Overview

While risk-stratified post-hepatectomy pathways (RSPHPs) reduce length-of-stay, can they stratify hepatectomy patients by risk of early postoperative events. 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. 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). RSPHPs can reliably stratify patients by risks of readmission or need for an IR procedure by predicting the most frequent period for these events. •RSPHPs stratify patients by risk of readmission or need for IR procedure by predicting the frequency of these events.•Knowledge of hepatectomy complexity and risk of complications informs intensity of postoperative follow-up after hepatectomy.•Utilization of telehealth for lower risk patients may minimize loss of time and money while maintaining excellent outcomes.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Enhanced recovery / Female / Hepatectomy / Hepatectomy - adverse effects / Hepatobiliary surgery / Hospitalization / Humans / Laparoscopy / Length of Stay - statistics & numerical data / Liver / Liver Neoplasms - surgery / Liver resection / Male / Metastasis / Middle Aged / Minimally invasive surgery / Morbidity / Patient Discharge / Patient Readmission - statistics & numerical data / Patients / Perioperative complications / Plateaus / Postoperative Complications - epidemiology / Quality improvement / Radiology / Readmission / Retrospective Studies / Risk / Risk Assessment / Statistical analysis / Surgery / Surgical outcomes