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Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Association between anesthesiologist volume and postoperative outcomes in hepatectomy and pancreatectomy
Jackson A Baril1, Emma Holler1, Cary Jo R Schlick1
1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Background:
Intraoperative fluid and hemodynamic management impact postoperative outcomes. Few studies have examined anesthesiologist volume-outcomes in hepato-pancreato-biliary surgery. The objectives of this study are to describe anesthesiologist experience levels in hepatectomy and pancreatectomy and examine their association with intraoperative intravenous fluids and postoperative outcomes.
Methods:
Adult patients who underwent hepatectomy or pancreatectomy from 2017 to 2023 were identified at a single center. For each case, anesthesiologist volume was defined as the number of pancreatectomies, hepatectomies, or both supported primarily by that anesthesiologist in the preceding 12 months. Primary outcomes of interest were intraoperative intravenous fluid volume and 30-day serious morbidity.
Results:
Of 3,016 patients included, 1,868 (61.9%) underwent pancreatectomy and 1,148 (38.1%) underwent hepatectomy. The median anesthesiologist experience was 14 (interquartile range, 9-18) in pancreatectomies, 8 (interquartile range, 5-12) in hepatectomies, and 21 (interquartile range, 14-29) combined. High-volume anesthesiologist cases were defined as the 75th percentile. High-volume anesthesiologists were not associated with volume of intravenous fluid (coefficient = -19.0 mL, 95% confidence interval, -116.5 to 78.4, P = .70). After adjusting for patient factors, surgeon, and operation type, high-volume anesthesiologists were not significantly associated with serious morbidity overall (adjusted odds ratio, 0.80; 95% confidence interval, 0.64-1.02, P = .07). However, operation-specific high-volume anesthesiologists were associated with decreased serious morbidity in pancreatectomy (adjusted odds ratio, 0.72; 95% confidence interval, 0.55-0.95, P = .02) but not in hepatectomy (adjusted odds ratio, 0.92; 95% confidence interval, 0.62-1.35, P = .66).
Conclusions:
A volume-outcome relationship was found between anesthesiologist experience with pancreatectomy and morbidity but not in intravenous fluid use, hepatectomy, or pancreatectomy and hepatectomy combined. The impact of anesthesiologist care in pancreatic surgery may relate to anesthesiologist experience.
