Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis

2021 ◽  
Author(s):  
Andrea Benedetti Cacciaguerra ◽  
Burak Görgec ◽  
Jacopo Lanari ◽  
Federica Cipriani ◽  
Nadia Russolillo ◽  
...  
Keyword(s):  
Propensity Score ◽  
Surgical Approach ◽  
Major Hepatectomy ◽  
Cirrhotic Patients

BURDEN OF MORTALITY AND DISEASE ATTRIBUTABLE TO HOSPITALIZED ATRIAL FIBRILLATION IN CIRRHOTIC PATIENTS IN THE UNITED STATES: A NATIONWIDE, PROPENSITY SCORE MATCHED ANALYSIS

2019 ◽  
Vol 73 (9) ◽  
pp. 359
Author(s):  
Tarun Jacob Bathini ◽  
Wisit Cheungpasitporn ◽  
Charat Thongprayoon ◽  
Ronpichai Chokesuwattanaskul ◽  
Patompong Ungprasert ◽  
...  
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Propensity Score ◽  
The United States ◽  
Cirrhotic Patients

Laparoscopic major hepatectomy for hepatocellular carcinoma in elderly patients: a multicentric propensity score‑based analysis

2020 ◽  
Author(s):  
Antonella Delvecchio ◽  
Maria Conticchio ◽  
Francesca Ratti ◽  
Maximiliano Gelli ◽  
Ferdinando Massimiliano Anelli ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Elderly Patients ◽  
Major Hepatectomy ◽  
Laparoscopic Major Hepatectomy

scholarly journals Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study

2019 ◽  
Vol 69 (10) ◽  
pp. 1731-1739 ◽  
Author(s):  
Michele Bartoletti ◽  
Maddalena Giannella ◽  
Russell E Lewis ◽  
Paolo Caraceni ◽  
Sara Tedeschi ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Propensity Score ◽  
Regression Model ◽  
Bloodstream Infection ◽  
Multicenter Study ◽  
Cox Regression ◽  
Intermittent Infusion ◽  
Beta Lactams ◽  
Cirrhotic Patients ◽  
Extended Infusion

Abstract Background We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI). Methods The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching. Results Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11–0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9–32.3; P < .0001) estimated with propensity score matching. A significant reduction in 30-day mortality was also observed in the subgroups of patients with sepsis (HR, 0.21; 95% CI, 0.06–0.74), acute-on-chronic liver failure (HR, 0.29; 95% CI, 0.03–0.99), and a model for end-stage liver disease score ≥25 (HR, 0.26; 95% CI, 0.08–0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06–2.47]). Conclusions C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge.

Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching

2015 ◽  
Vol 55 (4) ◽  
pp. 291-301 ◽  
Author(s):  
Shogo Tanaka ◽  
Shigekazu Takemura ◽  
Hiroji Shinkawa ◽  
Takayoshi Nishioka ◽  
Genya Hamano ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Propensity Score Matching ◽  
Activity Index ◽  
Disease Free Survival ◽  
Intraoperative Blood Loss ◽  
Laparoscopic Hepatic Resection ◽  
Cirrhotic Patients

Background/Purpose: Laparoscopic hepatic resection (LH) for hepatocellular carcinoma (HCC) has gradually gained ground as a safe and minimally invasive treatment, although LH for cirrhotic patients remains challenging. Methods: Between January 2007 and August 2014, 28 and 57 patients with histologically proven cirrhosis (histological activity index, fibrosis score 4) underwent pure LH and open hepatic resection (OH; less than segmentectomy), respectively, for peripheral HCC ≤5 cm. To correct the difference in clinicopathological factors, including difficulty scores, between the two groups, propensity score matching was used at a 1:1 ratio, which resulted in a comparison of 20 patients per group. We compared the short- and long-term outcomes of LH and OH to investigate the efficacy of LH. Results: Clinicopathological variables, including difficulty scores, were well balanced between the two groups. The incidence of complications and mean intraoperative blood loss were lower in the LH group than the OH group (0 vs. 45% and 180 vs. 440 ml, p = 0.001 and 0.04, respectively). The 3-year disease-free survival rate was 42% in the LH group and 30% in the OH group (p = 0.533), whereas the 5-year overall survival rates were 46 and 60%, respectively (p = 0.606). Conclusions: LH is a safe and effective treatment option for cirrhotic patients with HCC in terms of intraoperative blood loss and morbidity.

Esophagectomies for malignancy among general and thoracic surgeons: A propensity score-matched NSQIP analysis stratified by surgical approach.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 166-166
Author(s):  
Shravan Leonard-Murali ◽  
Tommy Ivanics ◽  
Hassan Nasser ◽  
Amy Tang ◽  
Zane T. Hammoud
Keyword(s):  
Propensity Score ◽  
Anastomotic Leak ◽  
Surgical Approach ◽  
Positive Margin ◽  
Perioperative Outcomes ◽  
National Database ◽  
Matched Cohort ◽  
Improvement Program ◽  
Positive Margin Rate ◽  
Grade 3

166 Background: Training of general and thoracic surgeons continues to diverge, especially with the increasing role for minimally invasive surgical (MIS) approaches. Previous studies of esophagectomy outcomes by specialty do not adequately address malignancy or surgical approach. We sought to evaluate perioperative outcomes of esophagectomy for malignancy stratified by surgical specialty and approach using a national database. Methods: The National Surgical Quality Improvement Program (NSQIP) Targeted Esophagectomy Dataset was queried for esophagectomies for malignancy and grouped by surgeon specialty: thoracic surgery (TS) or general surgery (GS). Those with missing data were excluded (n = 6). To account for confounding due to specialty selection bias, we performed propensity score matching (PSM) by age, body mass index, ethnicity, American Society of Anesthesiologists class ³ 3, and surgical approach in a 1:1 ratio. An absolute standardized difference of ≤ 0.1 was considered an appropriate balance. The primary outcome was mortality and secondary outcomes were anastomotic leak, Clavien-Dindo grade ≥ 3 and positive margin rate. Univariate logistic regression analysis was performed for these outcomes on the matched cohort, with stratification by surgical approach (open vs. MIS). Results: A total of 1463 patients met inclusion criteria (512 GS, 951 TS). After PSM each group was comprised of 512 patients with similar demographics, neoadjuvant chemotherapy and radiation rates, and preoperative stage. The TS group consisted of 169 (33.0%) open and 343 (67.0%) MIS cases, while the GS group consisted of 177 (34.6%) open and 335 (65.4%) MIS cases. Postoperative complications, including surgical site infection, pneumonia, pulmonary embolism, stroke, and myocardial infarction were similar between matched groups, and remained similar when stratified by surgical approach. Mortality rates were similar between the TS and GS groups, both overall (14 (2.7%) vs. 10 (2.0%)) and when stratified by surgical approach (MIS: 11 (3.2%) vs. 10 (3.0%), open: 3 (1.8%) vs. 0 (0%)). By univariate analysis of the matched cohort stratified by surgical approach, TS patients had similar odds as GS patients of anastomotic leak (open: adjusted odds ratio (AOR) = 1.11, 95% confidence interval (95%CI) = 0.58 – 2.15, p = 0.75; MIS: AOR = 0.70, 95%CI = 0.47 – 1.04, p = 0.08), Clavien-Dindo grade ≥ 3 (open: AOR = 1.27, 95%CI = 0.79 – 2.06, p = 0.32; MIS: AOR = 1.01, 95%CI = 0.73 – 1.39, p = 0.97), positive surgical margins (open: AOR = 0.75, 95%CI = 0.33 – 1.68, p = 0.49; MIS: AOR = 0.62, 95%CI = 0.35 – 1.07, p = 0.09), and mortality (open: unable to be calculated due to 0 deaths in the GS group; MIS: AOR = 1.08, 95%CI = 0.45 – 2.62, p = 0.87). Conclusions: Esophagectomy for malignancy had a similar perioperative safety profile and positive margin rate among general and thoracic surgeons, regardless of surgical approach.

scholarly journals ICG Clearance in Assessing Cirrhotic Patients with Hepatocellular Carcinoma for Major Hepatic Resection

HPB Surgery ◽  
1997 ◽  
Vol 10 (3) ◽  
pp. 182-183 ◽  
Author(s):  
Seigo Kitano ◽  
Yang-II Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Mortality Rate ◽  
Blood Loss ◽  
Hospital Mortality ◽  
Chronic Active Hepatitis ◽  
Major Hepatectomy ◽  
Selection Criterion ◽  
Tertiary Referral Center ◽  
Icg Clearance ◽  
Cirrhotic Patients

Objective: To deWne the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality.Design: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child's A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survery was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994.Setting: A tertiary referral center.Patients: The preoperative, intraoperative, and post-operative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected.Intervention: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. Main Outcome Measure: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy.Results: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P=.01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was cutoff level that could maximally separate the patients with cirrhosis with and without mortality.Conclusion: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.

scholarly journals Role of routine drainage after hepatectomy in non-cirrhotic patients: A Multi-institutional French Propensity Score Analysis

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e29
Author(s):  
M. Gelli ◽  
M.A. Allard ◽  
O. Farges ◽  
E. Vibert ◽  
F.-R. Pruvot ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Score Analysis ◽  
Cirrhotic Patients

scholarly journals Risk factors for hepatic insufficiency after major hepatectomy in non-cirrhotic patients

2019 ◽  
Vol 42 (1) ◽  
pp. 251-255
Author(s):  
Yoshiro Fujii ◽  
Atsushi Nanashima ◽  
Masahide Hiyoshi ◽  
Naoya Imamura ◽  
Koichi Yano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Major Hepatectomy ◽  
Hepatic Insufficiency ◽  
Cirrhotic Patients
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