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Readmissions After Surgery for Colorectal Liver Metastases: A Propensity Score Analysis From the Colorectal Liver
Heidy Cos1, Cristian D Valenzuela1, Omeed Moaven1
1Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA.
Background:
Readmission is considered as a surgical quality indicator. More data regarding predictors of readmission and outcomes after surgery for colorectal liver metastasis are needed. Using a propensity score match to create a 1:2 match of cases:controls for 90-day. Readmission, the matching variables used for balance included age, tumor size, estimated blood loss, and type of resection (minor or major). T-tests were used for continuous measures, Fisher's exact test was used for categorical data, and the Kaplan-Meier method was used to estimate survival. p < 0.05 was considered significant.
Methods:
Retrospectively examined 935 patients with CLM from 2000 to 2018. Using a propensity score match to create a 1:2 match of cases:controls for 90-day. Readmission, the matching variables used for balance included age, tumor size, estimated blood loss, and type of resection (minor or major). T-tests were used for continuous measures, Fisher's exact test was used for categorical data, and the Kaplan-Meier method was used to estimate survival. p < 0.05 was considered significant.
Results:
935 patients were included in the initial sample with 896 eligible for inclusion in the propensity matching. The average age of the population was 59% and 59% male. Overall readmission rate was 8.0%. Median time to readmission was 14 days. In the propensity score matched sample, readmitted patients had higher rates of organ space infection (28% vs 2% and p < 0.0001), bile leak (26% vs 1% and p < 0.0001), and liver failure (9% vs 2% and p = 0.042). There was no difference in LOS (7 days versus six days and p = 0.40), overall survival (median 39.7 vs 41.0 months and p = 0.79), or rate of adjuvant therapy (68% for both and p > 0.99).
Conclusion:
Patients readmitted for intermediate and late complications after surgery for CLM can recover and receive adjuvant therapy with no adverse effect on overall survival. Organ space infection, bile leak, and liver failure are highly associated with readmission.
