Optimal hepatic surgery: Are we making progress in North America?

Area of Science:

• Hepatobiliary Surgery
• Surgical Outcomes Research
• Minimally Invasive Surgery

Background:

• Hepatic surgery carries significant risks, necessitating continuous improvement in outcomes.
• Advancements in regionalization and minimally invasive techniques aim to enhance patient results.
• Standardized best practices have been established to improve hepatic surgery outcomes.

Purpose of the Study:

• To determine if optimal outcomes in hepatic surgery have improved in recent years.
• To analyze trends in hepatic surgery outcomes between 2014 and 2018.
• To assess the impact of minimally invasive approaches on surgical outcomes.

Main Methods:

• Analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2014-2018).
• Separate analyses for partial (≤2 segments), major (≥3 segments), and all hepatectomies.
• Definition of optimal hepatic surgery: absence of mortality, serious morbidity, reoperation, prolonged stay, or readmission.

Main Results:

• Minimally invasive hepatectomies increased from 25.6% to 29.6% (P < .01).
• Mortality, sepsis, bile leaks, liver failure, and length of stay all decreased over the study period (P < .05).
• Optimal hepatic surgery increased for partial and all hepatectomies (OR 1.05 and 1.04, respectively; P < .01).

Conclusions:

• Minimally invasive hepatectomies have increased, while key adverse outcomes have decreased.
• Optimal hepatic surgery rates have risen, especially for partial hepatectomies.
• Improvements in hepatic surgery reflect advancements in techniques and quality initiatives.