Timing and Severity of Postoperative Complications and Associated 30-Day Mortality Following Hepatic Resection: a National Surgical Quality Improvement Project Study

Abstract

BackgroundThe effect of varying severity and timing of complications after hepatic resection on 30-day mortality has not been thoroughly examined. MethodsNational 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. ResultsAmong 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. ConclusionApproximately 1 in 10 patients developed multiple complications following hepatectomy. Timing and severity of complications were independently associated with 30-day mortality.