Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy.,HPB

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Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy.
HPB ( IF 2.7 ) Pub Date : 2019-07-23 , DOI: 10.1016/j.hpb.2019.06.011
Q Lina Hu ₁ , Jason B Liu ₂ , Ryan J Ellis ₃ , Jessica Y Liu ₄ , Anthony D Yang ₅ , Michael I D'Angelica ₆ , Clifford Y Ko ₁ , Ryan P Merkow ₃

Affiliation

Background

Endoscopic biliary stenting (EBS) and percutaneous transhepatic biliary drainage (PTBD) are two techniques used for preoperative biliary drainage prior to hepatobiliary resection. The objectives of this study were to determine predictors of the drainage technique selection and to evaluate the association between drainage technique and postoperative outcomes.

Methods

Using ACS NSQIP data (2014–2017), patients who underwent preoperative biliary drainage prior to hepatobiliary resection for malignancy were identified. Separate multivariable-adjusted, propensity score (PS) adjusted, and PS matched logistic regression models were constructed to evaluate the association between drainage technique and postoperative outcomes.

Results

Of 527 patients identified, 431 (81.8%) received EBS and 96 (18.2%) received PTBD. Patients who underwent PTBD had more preoperative co-morbidities, including higher ASA class, recent weight loss, and hypoalbuminemia (all p < 0.05). After multivariable adjustment, PTBD was significantly associated with 30-day DSM (OR 1.92, 95% CI 1.24–2.97, p = 0.004), overall SSI (OR 1.74, 95% CI 1.10–2.76, p = 0.019), and superficial SSI (OR 2.08, 95% CI 1.20–3.60, p = 0.010). These findings remained significant for both PS-adjusted and PS-matched models.

Conclusion

Patients undergoing hepatobiliary resection selected for PTBD had significantly more preoperative co-morbidities and nutritional deficits. Compared to EBS, PTBD was associated with significantly higher odds of postoperative morbidity and mortality.

中文翻译：

术前胆道引流技术与可切除肝胆恶性肿瘤患者术后预后的关系。

背景

内窥镜胆道支架置入术 (EBS) 和经皮经肝胆道引流术 (PTBD) 是肝胆切除术前用于术前胆道引流的两种技术。本研究的目的是确定引流技术选择的预测因素，并评估引流技术与术后结果之间的关联。

方法

使用 ACS NSQIP 数据（2014-2017），确定了在恶性肿瘤肝胆切除术前接受术前胆道引流的患者。分别构建了多变量调整、倾向评分 (PS) 调整和 PS 匹配逻辑回归模型，以评估引流技术与术后结果之间的关联。

结果

在确定的 527 名患者中，431 名 (81.8%) 接受了 EBS，96 名 (18.2%) 接受了 PTBD。接受 PTBD 的患者有更多的术前合并症，包括较高的 ASA 等级、近期体重减轻和低白蛋白血症（所有 p < 0.05）。多变量调整后，PTBD 与 30 天 DSM（OR 1.92，95% CI 1.24-2.97，p = 0.004）、总体 SSI（OR 1.74，95% CI 1.10-2.76，p = 0.019）和表面 SSI 显着相关（OR 2.08，95% CI 1.20–3.60，p = 0.010）。这些发现对于 PS 调整和 PS 匹配模型仍然很重要。