Half of Postoperative Deaths After Hepatectomy may be Preventable: A Root-cause Analysis of a Prospective Multicenter Cohort Study. Issue 5 (November 2018)

• Record Type: Journal Article
• Authors: Khaoudy, Iman; Farges, Olivier; Boleslawski, Emmanuel; Vibert, Eric; Soubrane, Olivier; Adham, Mustapha; Mabrut, Jean Yves; Christophe, Laurent; Bachellier, Philippe; Scatton, Olivier; Le Treut, Yves-Patrice; Regimbeau, Jean Marc
• Is Part Of: Annals of surgery. Volume 268:Issue 5(2018:Nov.)
• Publication Date: 2018-11
• Subjects: liver resection -- mortality after hepatectomy -- root-cause analysis; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002837
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To perform a retrospective root-cause analysis of the causes of postoperative mortality after hepatectomy. Background: Mortality after liver resection has not decreased over the past decade. Methods: The study population was a prospective cohort of hepatectomies performed at hepatic, pancreatic, and biliary (HPB) centers between October 2012 and December 2014. Of the 1906 included patients, 90 (5%) died within 90 days of surgery. Perioperative data were retrieved from the original medical records. The root-cause analysis was performed independently by a senior HBP-surgeon and a surgical HBP-fellow. The objectives were to record the cause of death and then assess whether (1) the attending surgeon had identified the cause of death and what was it?, (2) the intra- and postoperative management had been appropriate, (3) the patient had been managed according to international guidelines, and (4) death was preventable. A typical root cause of death was defined. Results: The cause of death was identified by the index surgeon and by the root-cause analysis in 84% and 88% of cases, respectively. Intra- and postoperative management procedures were inadequate in 33% and 23% of the cases, respectively. Guidelines were not followed in 57% of cases. Overall, 47% of the deaths were preventable. The typical root cause of death was insufficient evaluation of the tumor stage or tumor progression in a patient with malignant disease resulting in a more invasive procedure than expected. Conclusion: Measures to ensure compliance with guidelines and (in the event of unexpected operative findings) better within-team communication should be implemented systematically.