Conditional cumulative incidence of postoperative complications stratified by complexity classification for laparoscopic liver resection: Optimization of in-hospital observation.

Autor: Mazzotta AD; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France. Electronic address: alex.mazzotta@gmail.com., Kawaguchi Y; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan., Pantel L; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France., Tribillon E; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France., Bonnet S; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France., Gayet B; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France., Soubrane O; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2023 Feb; Vol. 173 (2), pp. 422-427. Date of Electronic Publication: 2022 Aug 27.
DOI: 10.1016/j.surg.2022.07.026
Abstrakt: Background: The optimal in-hospital observation periods associated with minimal risks of complications and unplanned readmission after laparoscopic liver resection are unknown. The purpose of this study was to assess changes in the risks of postoperative complications over time.
Methods: Surgical complexity of laparoscopic liver resection was stratified into grades I (low complexity), II (intermediate), and III (high) using our 3-level complexity classification. The cumulative incidence rate and conditional probability of postoperative complication and risk factors for complication Clavien-Dindo grade ≥II (defined as treatment-requiring complications) were assessed.
Results: The cumulative incidence of treatment-requiring complications was higher in patients undergoing grade III resection than in patients undergoing grade I resection (32.3% vs 10.4%, P < .001) and grade II resection (32.3% vs 20.7%, P = .019). The conditional probability of postoperative complication stratified by our complexity classification decreased over time and was <10% for patients undergoing grade I resection on postoperative day 1, grade II resection on postoperative day 4, and grade III resection on postoperative day 10.
Conclusion: The conditional cumulative incidence of treatment-requiring complications for patients undergoing laparoscopic liver resection is well stratified based on the 3-level complexity classification. Conditional complication risk analysis stratified by the 3 complexity grades may be useful for optimizing in-hospital observation after laparoscopic liver resection.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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