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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2020

01-11-2020 | Liver Resection

Minimally invasive hepatectomy is associated with decreased morbidity and resource utilization in the elderly

Authors: May C. Tee, Leo Chen, Devon Peightal, Jan Franko, Peter T. Kim, Rushin D. Brahmbhatt, Shankar Raman, Charles H. Scudamore, Stephen W. Chung, Maja Segedi

Published in: Surgical Endoscopy | Issue 11/2020

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Abstract

Background

The aim of this study was to evaluate whether elderly patients undergoing elective hepatectomy experience increased morbidity/mortality and whether these outcomes could be mitigated by minimally invasive hepatectomy (MIH).

Methods

15,612 patients from 2014 to 2017 were identified in the Hepatectomy Targeted Procedure Participant Use File of the American College of Surgeons National Surgical Quality Improvement Program. Multivariable logistic regression models were constructed to examine the effect of elderly status (age ≥ 75 years, N = 1769) on outcomes with a subgroup analysis of elderly only patients by open (OH) versus MIH (robotic, laparoscopic, and hybrid, N = 4044). Propensity score matching was conducted comparing the effect of MIH to OH in elderly patients to ensure that results are not the artifact of imbalance in baseline characteristics.

Results

Overall, elderly patients had increased risk for 30-day mortality, major morbidity, prolonged length of hospital stay, and discharge to destination other than home. In the elderly subgroup, MIH was associated with decreased major morbidity (OR 0.71, P = 0.031), invasive intervention (OR 0.61, P = 0.032), liver failure (OR 0.15, P = 0.011), bleeding (OR 0.46, P < 0.001), and prolonged length of stay (OR 0.46, P < 0.001). Propensity score-matched analyses successfully matched 4021 pairs of patients treated by MIH vs. OH, and logistic regression analyses on this matched sample found that MIH was associated with decreased major complications (OR 0.69, P = 0.023), liver failure (OR 0.14, P = 0.010), bile leak (OR 0.46, P = 0.009), bleeding requiring transfusion (OR 0.46, P < 0.001), prolonged length of stay (OR 0.46, P < 0.001), and discharge to destination other than home (OR 0.691, P = 0.035) compared to OH.

Conclusion

MIH is associated with decreased risk of major morbidity, liver failure, bile leak, bleeding, prolonged length of stay, and discharge to destination other than home among elderly patients in this retrospective study. However, MIH in elderly patients does not protect against postoperative mortality.
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Metadata
Title
Minimally invasive hepatectomy is associated with decreased morbidity and resource utilization in the elderly
Authors
May C. Tee
Leo Chen
Devon Peightal
Jan Franko
Peter T. Kim
Rushin D. Brahmbhatt
Shankar Raman
Charles H. Scudamore
Stephen W. Chung
Maja Segedi
Publication date
01-11-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07298-5

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