TY - JOUR
T1 - Individual components of post-hepatectomy care pathways have differential impacts on length of stay
AU - Martin, Allison N.
AU - Concors, Seth J.
AU - Kim, Bradford J.
AU - Newhook, Timothy E.
AU - Arvide, Elsa M.
AU - Dewhurst, Whitney L.
AU - Kawaguchi, Yoshikuni
AU - Tran Cao, Hop S.
AU - Katz, Matthew H.G.
AU - Vauthey, Jean Nicolas
AU - Tzeng, Ching Wei D.
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/1
Y1 - 2023/1
N2 - Background: The value of individual variable contributions to post-hepatectomy length of stay (LOS) are difficult to quantify within bundled care pathways. Methods: Poisson regression and marginal effects models for prolonged post-hepatectomy LOS (>25% median) included Kawaguchi-Gayet (KG) complexity, perioperative variables, and pathways (minimally-invasive = MIS; low-intermediate-risk = KGI/II; high-risk = KGIII; combination). Results: Median LOS was 2, 4, 5, and 5 days for MIS, KGI/II, KGIII and combination pathways (N = 978). Poisson regression identified age, intraoperative fluids, delayed diet tolerance, and combination cases as associated with increased LOS (p < 0.01). Marginal effects analysis demonstrated the following added probability of longer LOS: each year of age 0.03x, 250 mL intraoperative fluids 0.06x, each operative hour 0.2x, additional day before diet tolerance 0.4x, combination cases 0.7x. MIS was associated with 1.2x increased probability of shorter LOS. Conclusions: Optimizing intraoperative fluids, operative time, and postoperative diet, while favoring MIS approach when feasible, may maximize effects of post-hepatectomy care pathways to reduce LOS.
AB - Background: The value of individual variable contributions to post-hepatectomy length of stay (LOS) are difficult to quantify within bundled care pathways. Methods: Poisson regression and marginal effects models for prolonged post-hepatectomy LOS (>25% median) included Kawaguchi-Gayet (KG) complexity, perioperative variables, and pathways (minimally-invasive = MIS; low-intermediate-risk = KGI/II; high-risk = KGIII; combination). Results: Median LOS was 2, 4, 5, and 5 days for MIS, KGI/II, KGIII and combination pathways (N = 978). Poisson regression identified age, intraoperative fluids, delayed diet tolerance, and combination cases as associated with increased LOS (p < 0.01). Marginal effects analysis demonstrated the following added probability of longer LOS: each year of age 0.03x, 250 mL intraoperative fluids 0.06x, each operative hour 0.2x, additional day before diet tolerance 0.4x, combination cases 0.7x. MIS was associated with 1.2x increased probability of shorter LOS. Conclusions: Optimizing intraoperative fluids, operative time, and postoperative diet, while favoring MIS approach when feasible, may maximize effects of post-hepatectomy care pathways to reduce LOS.
KW - Enhanced recovery
KW - Hepatectomy
KW - Length of stay
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U2 - 10.1016/j.amjsurg.2022.09.050
DO - 10.1016/j.amjsurg.2022.09.050
M3 - Article
C2 - 36207173
AN - SCOPUS:85139341635
SN - 0002-9610
VL - 225
SP - 53
EP - 57
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 1
ER -