Is prolonged operative time associated with postoperative complications in liver surgery? An international multicentre cohort study of 5424 patients

期刊论文
发表日期：

2024年9月30日

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Christoph Kuemmerli,
Jasper P. Sijberden,
Federica Cipriani,
Daniel Osei-Bordom,
Davit Aghayan,
Jacopo Lanari,
Celine de Meyere,
Andrea Benedetti Cacciaguerra,
Fernando Rotellar,
David Fuks,
Rong Liu,
Marc G. Besselink,
Giuseppe Zimmitti,
Andrea Ruzzenente,
Fabrizio di Benedetto,
Iswanto Succandy,
Mikhail Efanov,
Riccardo Memeo,
Elio Jovine,
Dionisios Vrochides,
Ibrahim Dagher,
Roland Croner,
Santi Lopez-Ben,
David Geller,
Jawad Ahmad,
Tom Gallagher,
Steven White,
Adnan Alseidi,
Brian K. P. Goh,
Ernesto Sparrelid,
Francesca Ratti,
Ravi Marudanayagam,
Åsmund Avdem Fretland,
Marco Vivarelli,
Mathieu D’Hondt,
Umberto Cillo,
Bjørn Edwin,
Robert P. Sutcliffe,
Luca A. Aldrighetti,
Mohammed Abu Hilal

摘要

Background

The relation between operative time and postoperative complications in liver surgery is unclear. The aim of this study is to assess the impact of operative time on the development of postoperative complications in patients who underwent minimally invasive or open liver resections of various anatomical extent and technical difficulty levels.

Methods

In this retrospective cohort study, patients that underwent a right hemihepatectomy (RH), technically major resection (anatomically minor resection in segment 1, 4a, 7 or 8; TMR) or left lateral sectionectomy (LLS) between 2000 and 2022 were extracted from a multicenter database comprising the prospectively maintained databases of 31 centers in 13 countries. Minimally invasive procedures performed during the learning curve were omitted. Logistic regression models, performed separately for 9 different groups based on stratification by procedure type and allocated surgical approach, were used to assess the association between the fourth quartile of operative time (25% of patients with the longest operative time) and postoperative complications.

Results

Overall, 5424 patients were included: 1351 underwent RH (865 open, 373 laparoscopic and 113 robotic), 2821 TMR (1398 open, 1225 laparoscopic and 198 robotic), and 1252 LLS (241 open, 822 laparoscopic and 189 robotic). After adjusting for potential confounders (age, BMI, gender, ASA grade, previous abdominal surgery, disease type and extent, blood loss, Pringle, intraoperative transfusions and incidents), the fourth quartile of operative time, compared to the first three quartiles, was associated with an increased risk of postoperative complications after open, laparoscopic and robotic TMR (aOR 1.35, p = 0.031; aOR 1.74, p = 0.001 and aOR 3.11, p = 0.014, respectively), laparoscopic and robotic RH (aOR 1.98, p = 0.018 and aOR 3.28, p = 0.055, respectively) and solely laparoscopic LLS (aOR 1.69, p = 0.019).

Conclusions

A prolonged operative time is associated with an increased risk of postoperative complications, although it remains to be defined if this is a causal relationship.