Preoperative Risk Factors for 30-Day Reoperation in Patients Undergoing Hepatic Resections for Malignancy

Although hepatic resections are safe, reoperation within 30 days after the index operation continues to be a serious adverse event. This study identifies preoperative risk factors predictive of reoperation following hepatic resection for malignancy. Using appropriate CPT codes, all patients undergoing liver resection were extracted from the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) Participant Use Files between years 2005 and 2010. Subsets of patients with malignancies of the liver were identified using ICD-9 diagnosis. Primary outcome of the study was 30-day reoperations. Preoperative patient characteristics were compared by reoperations within 30 days through both univariate analysis and multivariate logistic regression. A total of 4812 patients who underwent hepatic resections for malignancy were extracted. Overall mortality and morbidity rates were 2.7 and 28.2 %, respectively. Multivariate logistic regression showed association between return to operating room and male gender (OR = 1.58, p = 0.0069), dependent functional status (OR = 3.35, p = 0.0021), intrahepatic primary biliary cancer (OR = 2.11, p = 0.0013), history of angina (OR 4.41, p = 0.023), and preoperative wound infection (OR = 3.8, p = 0.0029). Return to the operating room within 30 days after hepatic resection is an adverse event associated with significant morbidity. Identifying associated preoperative risk factors can help optimize patients and set up more appropriate expectations from resection.