Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707...

Area of Science:

• Hepatobiliary surgery
• Surgical outcomes research
• Medical technology assessment

Background:

• Hepatectomy indications and complexity have evolved due to advancements in perioperative care and surgical techniques.
• The impact of these advancements on short-term perioperative outcomes over time requires detailed evaluation.

Purpose of the Study:

• To analyze trends in perioperative outcomes for patients undergoing hepatectomy over an 18-year period.
• To compare outcomes across different eras of hepatectomy to identify improvements.

Main Methods:

• A retrospective analysis of 3707 consecutive hepatectomies performed between 1998 and 2015.
• Comparison of perioperative outcomes, including the Comprehensive Complication Index (CCI), across three eras: 1998-2003, 2004-2009, and 2010-2015.

Main Results:

• Hepatectomy complexity increased, with higher rates of major hepatectomy, 2-stage hepatectomy, and portal vein embolization.
• Significant reductions observed in median blood loss, transfusion rates, length of hospitalization, and 90-day mortality.
• The most recent era (2010-2015) was associated with a lower incidence of severe complications (CCI ≥26.2).

Conclusions:

• Despite increased surgical complexity, advancements in perioperative care and surgical techniques have led to improved outcomes.
• The most current era of hepatectomy demonstrates a significant decrease in complication rates and mortality.