Understanding conditional cumulative incidence of complications following liver resection to optimize hospital stay.

Abstract

After liver resection, the in-hospital observation periods associated with minimal risks for complications and unplanned readmission remains unclear. This study aimed to assess changes in risks of complications over time. Surgical complexity of liver resection was stratified into grades I (low complexity), II (intermediate), and III (high). The cumulative incidence rate and risk factors for complication≥Clavien-Dindo grade II (defined as treatment-requiring complications) were assessed. Of 581 patients, grade I, II, and III resections were performed in 81 (13.9%), 119 (20.5%), and 381 patients (65.6%). Complexity grades (I vs. III, hazard ratio [HR] 0.45, P=0.007; II vs. III, HR 0.60, P=0.011) and background liver status (HR 1.76, P=0.004) were risk factors for treatment-requiring complications. The cumulative incidence rate of treatment-requiring complications was higher after grade III resection than grade I resection (38.1% vs. 16.1%, P<0.001) or grade II resection (38.1% vs. 25.2%, P=0.019). Without cirrhosis/chronic hepatitis, the cumulative incidence rate of treatment-requiring complications decreased to less than 10% on postoperative day (POD) 3 after grade I resection, POD 5 after grade II resection, and POD 10 after grade III resection. Conditional complication risk analysis stratified by surgical complexity may be useful for optimizing in-hospital observation.