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World Journal of Surgery
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Open Access 09-07-2022 | Original Scientific Report

Impact of Frailty on Short-Term Outcomes After Laparoscopic and Open Hepatectomy

Authors: D. Osei-Bordom, L. Hall, J. Hodson, K. Joshi, L. Austen, D. Bartlett, J. Isaac, D. F. Mirza, R. Marudanayagam, K. Roberts, B. V. Dasari, N. Chatzizacharias, R. P. Sutcliffe

Published in: World Journal of Surgery | Issue 10/2022

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Abstract

Background

Although laparoscopic hepatectomy (LH) is associated with improved short-term outcomes compared to open hepatectomy (OH), it is unknown whether frail patients also benefit from LH. The aim of this study was to evaluate the impact of frailty on post-operative outcomes after LH and OH.

Patients and methods

Consecutive patients who underwent LH and OH between January 2011 and December 2018 were identified from a prospective database. Frailty was assessed using the modified Frailty Index (mFI), with patients scoring mFI ≥ 1 deemed to be frail.

Results

Of 1826 patients, 34.7% (N = 634) were frail and 18.6% (N = 340) were elderly (≥ 75 years). Frail patients had significantly higher 90-day mortality (6.6% vs. 2.9%, p < 0.001) and post-operative complications (36.3% vs. 26.1%, p < 0.001) than those who were not frail, effects that were independent of patient age on multivariate analysis. For those undergoing minor resections, the benefits of LH vs. OH were similar for frail and non-frail patients. Length of hospital stay was 53% longer in OH (vs. LH) in frail patients, compared to 58% longer in the subgroup of non-frail patients.

Conclusions

Frailty is independently associated with inferior post-operative outcomes in patients undergoing hepatectomy. However, the benefits of laparoscopic (compared to open) hepatectomy are similar for frail and non-frail patients. Frailty should not be a contraindication to laparoscopic minor hepatectomy in carefully selected patients.
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Metadata
Title
Impact of Frailty on Short-Term Outcomes After Laparoscopic and Open Hepatectomy
Authors
D. Osei-Bordom
L. Hall
J. Hodson
K. Joshi
L. Austen
D. Bartlett
J. Isaac
D. F. Mirza
R. Marudanayagam
K. Roberts
B. V. Dasari
N. Chatzizacharias
R. P. Sutcliffe
Publication date
09-07-2022
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 10/2022
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-022-06648-0

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