Background

After liver resection, the in-hospital observation periods associated with minimal risks for complications and unplanned readmission remains unclear. This study aimed to assess changes in risks of complications over time.

Methods

Surgical complexity of liver resection was stratified into grades I (low complexity), II (intermediate), and III (high). The cumulative incidence rate and risk factors for complication ≥Clavien-Dindo grade II (defined as treatment-requiring complications) were assessed.

Results

Of 581 patients, grade I, II, and III resections were performed in 81 (13.9%), 119 (20.5%), and 381 patients (65.6%). Complexity grades (I vs. III, hazard ratio [HR] 0.45, P=0.007; II vs. III, HR 0.60, P=0.011) and background liver status (HR 1.76, P=0.004) were risk factors for treatment-requiring complications. The cumulative incidence rate of treatment-requiring complications was higher after grade III resection than grade I resection (38.1% vs. 16.1%, P<0.001) or grade II resection (38.1% vs. 25.2%, P=0.019). Without cirrhosis/chronic hepatitis, the cumulative incidence rate of treatment-requiring complications decreased to less than 10% on postoperative day (POD) 3 after grade I resection, POD 5 after grade II resection, and POD 10 after grade III resection.

Discussion

Conditional complication risk analysis stratified by surgical complexity may be useful for optimizing in-hospital observation.

中文翻译：

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了解肝切除术后并发症的条件累积发生率以优化住院时间

背景

肝切除术后，与并发症和非计划再入院风险最小相关的住院观察期仍不清楚。本研究旨在评估并发症风险随时间的变化。

方法

肝切除的手术复杂性分为I级（低复杂性）、II级（中级）和III级（高复杂度）。评估了并发症≥Clavien-Dindo II级（定义为需要治疗的并发症）的累积发生率和危险因素。

结果

在 581 名患者中，81 名（13.9%）、119 名（20.5%）和 381 名（65.6%）患者进行了 I、II 和 III 级切除术。复杂性等级（I 与 III，风险比 [HR] 0.45，P = 0.007；II 与 III，HR 0.60，P = 0.011）和背景肝脏状态（HR 1.76，P = 0.004）是需要治疗的风险因素并发症。III 级切除术后需治疗并发症的累积发生率高于 I 级切除（38.1% vs. 16.1%，P <0.001）或 II 级切除（38.1% vs. 25.2%，P=0.019）。在没有肝硬化/慢性肝炎的情况下，I级切除术后第3天（POD）、II级切除术后第5天和III级切除术后第10天，需要治疗的并发症的累积发生率降至10%以下。

讨论

按手术复杂性分层的条件并发症风险分析可能有助于优化住院观察。