BACKGROUND Anatomic hepatectomies can be associated with complicated post-operative recoveries, often with discharge to post-acute care facilities. This study identifies preoperative and intraoperative factors associated with increased risk for non-home discharge destination after major hepatectomy. METHODS Patients undergoing major hepatectomy were identified in the NSQIP Targeted Hepatectomy Dataset (2014-2016). Multivariable logistic regression was performed. Patients from 2014 to 2015 were used for training cohort with nomogram generation and 2016 for validation cohort. RESULTS Overall, 226 of 3750 patients (6.0%) were discharged to rehab, skilled care, or acute care facilities. Preoperative factors associated with non-home discharge on multivariable analysis were outside patient transfers, older age, presence of ascites, ASA physical status 3 or higher, and low preoperative hematocrit (all p < 0.05). Intraoperative factors significantly predictive were concurrent lysis of adhesions, Pringle maneuver, and biliary reconstruction (all p < 0.05). Predictors from testing cohort were validated in validation cohort. Nomograms based on preoperative variables alone and both preoperative and intraoperative variables were generated. CONCLUSION We identify several preoperative and intraoperative factors that are associated with increased risk for non-home discharge after major hepatectomy. Preoperative anemia represents a potentially modifiable risk factor. Nomograms for preoperative planning as well as immediately following surgery were generated.

中文翻译：

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大肝切除术后出院目的地的预测。

背景技术解剖型肝切除术可以与复杂的术后恢复相关，通常与出院后的护理机构有关。这项研究确定了术前和术中与大肝切除术后非出院目的地风险增加相关的因素。方法在NSQIP靶向肝切除术数据集（2014- 2016年）中确定接受大肝切除术的患者。进行多变量逻辑回归。2014年至2015年的患者用于训练列阵图生成的队列，2016年的患者用于验证队列。结果总体上，在3750名患者中，有226名（6.0％）出院了康复，专业护理或急症护理设施。在多变量分析中，与非出院相关的术前因素包括患者外来转移，年龄较大，存在腹水，ASA身体状况3或更高，术前血细胞比容低（所有p <0.05）。术中因素的显着预测是同时发生粘连溶解，普林格尔操作和胆道重建（所有p <0.05）。来自测试队列的预测变量在验证队列中进行了验证。仅根据术前变量以及术前和术中变量生成了线型图。结论我们确定了一些术前和术中因素，这些因素与大肝切除术后非家庭出院的风险增加有关。术前贫血代表潜在的可改变的危险因素。产生了术前计划以及手术后立即进行的诺法图。术中因素的显着预测是同时发生粘连溶解，普林格尔操作和胆道重建（所有p <0.05）。来自测试队列的预测变量在验证队列中进行了验证。仅根据术前变量以及术前和术中变量生成了线型图。结论我们确定了一些术前和术中因素，这些因素与大肝切除术后非家庭出院的风险增加有关。术前贫血代表潜在的可改变的危险因素。产生了术前计划以及手术后立即进行的诺法图。术中因素的显着预测是同时发生粘连溶解，普林格尔（Pringle）动作和胆道重建（所有p <0.05）。来自测试队列的预测变量在验证队列中进行了验证。仅根据术前变量以及术前和术中变量生成了线型图。结论我们确定了一些术前和术中因素，这些因素与大肝切除术后非家庭出院的风险增加有关。术前贫血代表潜在的可改变的危险因素。产生了术前计划以及手术后立即进行的诺法图。仅根据术前变量以及术前和术中变量生成了线型图。结论我们确定了一些术前和术中因素，这些因素与大肝切除术后非家庭出院的风险增加有关。术前贫血代表潜在的可改变的危险因素。产生了术前计划以及手术后立即进行的诺法图。仅根据术前变量以及术前和术中变量生成了线型图。结论我们确定了一些术前和术中因素，这些因素与大肝切除术后非家庭出院的风险增加有关。术前贫血代表潜在的可改变的危险因素。产生用于术前计划以及手术后立即进行的诺法图。