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Updated: Jul 7, 2025
Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma
Published on: May 24, 2024
Utilizing risk-stratified pathways to personalize post-hepatectomy discharge planning: A contemporary analysis of
Allison N Martin1, Timothy E Newhook2, Elsa M Arvide2
1Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Background:
While risk-stratified post-hepatectomy pathways (RSPHPs) reduce length-of-stay, can they stratify hepatectomy patients by risk of early postoperative events.
Methods:
90-day outcomes from consecutive hepatectomies were analyzed (1/1/2017-12/31/2021). Pre/post-pathway analysis was performed for pathways: minimally invasive surgery ("MIS"); non-anatomic resection/left hepatectomy ("low-intermediate risk"); right/extended hepatectomy ("high-risk"); "Combination" operations. Time-to-event (TTE) analyses for readmission and interventional radiology procedures (IRPs) was performed.
Results:
1354 patients were included: MIS/n= 119 (9 %); low-intermediate risk/n= 443 (33 %); high-risk/n= 328 (24 %); Combination/n= 464 (34 %). There was no difference in readmission (pre: 13 % vs. post:11.5 %, p = 0.398). There were fewer readmissions in post-pathway patients amongst MIS, low-intermediate risk, and Combination patients (all p > 0.1). 114 (8.4 %) patients required IRPs. Time-to-readmission and time-to-IR-procedure plots demonstrated lower plateaus and flatter slopes for MIS/low-intermediate-risk pathways post-pathway implementation (p < 0.001).
Conclusion:
RSPHPs can reliably stratify patients by risks of readmission or need for an IR procedure by predicting the most frequent period for these events.
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