The impact of minimally invasive surgery and frailty on post-hepatectomy outcomes. Issue 9 (September 2022)

• Record Type: Journal Article
• Authors: Maegawa, Felipe B.; Ahmad, Maria; Aguirre, Katherine; Elhanafi, Sherif; Chiba, Shintaro; Philipovskiy, Alexander; Tyroch, Alan H.; Konstantinidis, Ioannis T.
• Is Part Of: HPB. Volume 24:Issue 9(2022)
• Page Start: 1577
• Page End: 1584
• Publication Date: 2022-09
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2022.03.018
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: The impact of patient frailty on post-hepatectomy outcomes is not well studied. We hypothesized that patient frailty is a strong predictor of 30-day post-hepatectomy complications. Methods: The liver-targeted National Surgical Quality Improvement Program (NSQIP) database for 2014–2019 was reviewed. A validated modified frailty index (mFI) was used. Results: A total of 24, 150 hepatectomies were reviewed. Worsening frailty was associated with increased incidence of Clavien-Dindo grade IV complications (mFI 0, 1, 2, 3, 4 was 3.9%, 6.3%, 10%, 8.1%, 50% respectively; p < 0.001). Minimally invasive hepatectomies had a lower rate of Clavien-Dindo grade IV complications for non-frail (Laparoscopic: 1%, Robotic: 2.6%, Open: 4.6%; p < 0.001) and frail patients (Laparoscopic: 3%, Robotic: 2.3%, Open: 7.7%; p < 0.001). Frail patients experienced higher incidence of post-hepatectomy liver failure (5.4% vs 4.1% for non-frail; p < 0.001) and grade C liver failure (28% vs 21.1% for non-frail; p = 0.03). Incorporating mFI to Albumin-Bilirubin score (ALBI) improved its ability to predict Clavien-Dindo grade IV complications (AUC improved from 0.609 to 0.647; p < 0.001) and 30-day mortality (AUC improved from 0.663 to 0.72; p < 0.001). Conclusion: Worsening frailty correlates with increased incidence of Clavien-Dindo grade IV complications post-hepatectomy, whereas minimally invasive approaches decrease this risk. Incorporating frailty assessment to ALBI improves its ability to predict major postoperative complications and 30-day mortality.