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Journal of Surgical Oncology
Article . 2024 . Peer-reviewed
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Establishing the clinical relevance of grade A post‐hepatectomy liver failure

Authors: Dominic J. Vitello; Dhavan Shah; Bona Ko; Brian C. Brajcich; Xane D. Peters; Ryan P. Merkow; Henry A. Pitt; +1 Authors

Establishing the clinical relevance of grade A post‐hepatectomy liver failure

Abstract

Abstract Introduction The International Study Group of Liver Surgery's criteria stratifies post‐hepatectomy liver failure (PHLF) into grades A, B, and C. The clinical significance of these grades has not been fully established. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) hepatectomy‐targeted database was analyzed. Outcomes between patients without PHLF, with grade A PHLF, and grade B or C PHLF were compared. Univariate and multivariable logistic regression were performed. Results Six thousand two hundred seventy‐four adults undergoing elective major hepatectomy were included in the analysis. The incidence of grade A PHLF was 4.3% and grade B or C was 5.3%. Mortality was similar between patients without PHLF (1.2%) and with grade A PHLF (1.1%), but higher in those with grades B or C PHLF (25.4%). Overall morbidities rates were 19.3%, 41.7%, and 72.8% in patients without PHLF, with grade A PHLF, and with grade B or C PHLF, respectively ( p < 0.001). Grade A PHLF was associated with increased morbidity (grade A: odds ratios [OR] 2.7 [95% CI: 2.0−3.5]), unplanned reoperation (grade A: OR 3.4 [95% CI: 2.2−5.1]), nonoperative intervention (grade A: OR 2.6 [95% CI: 1.9−3.6]), length of stay (grade A: OR 3.1 [95% CI: 2.3−4.1]), and readmission (grade A: OR 1.8 [95% CI: 1.3−2.5]) compared to patients without PHLF. Conclusions Although mortality was similar between patients without PHLF and with grade A PHLF, other postoperative outcomes were notably inferior. Grade A PHLF is a clinically distinct entity with relevant associated postoperative morbidity.

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Keywords

Adult, Clinical Relevance, Postoperative Complications, Carcinoma, Hepatocellular, Liver Neoplasms, Humans, Hepatectomy, Liver Failure, Retrospective Studies

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
3
Top 10%
Average
Average
hybrid