Contemporary practice and short-term outcomes after liver resections in a complete national cohort

• Published in: Langenbeck's archives of surgery Vol. 404; no. 1; pp. 11 - 19
• Main Authors: Lassen, Kristoffer, Nymo, Linn Såve, Olsen, Frank, Brudvik, Kristoffer Watten, Fretland, Åsmund Avdem, Søreide, Kjetil
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2019
• Subjects: Abdominal Surgery; Aged; Cardiac Surgery; Cohort Studies; Female; General Surgery; Hepatectomy - adverse effects; Hepatectomy - statistics & numerical data; Humans; Laparoscopy - adverse effects; Laparoscopy - statistics & numerical data; Length of Stay; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Norway - epidemiology; Original Article; Postoperative Complications - epidemiology; Reoperation; Survival Rate; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery; Norway; Liver resection; National cohort; Laparoscopic; Short-term outcomes
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-018-1737-3

Background Improved outcome after liver resections have been reported in several series, but outcomes from national cohorts are scarce. Our aim was to evaluate nationwide practice and short-term outcomes after liver surgery in a universal healthcare system. Methods A complete 5-year cohort of all liver resections from the Norwegian Patient Registry (NPR). Short-term outcomes were aggregated length of stay (a-LoS), reoperation and 90-day mortality. Results Of 2118 liver resections, 605 (28.6%) were major, median age was 65 years and 1184 (55%) were male. Most common indication was metastatic disease ( n  = 1554; 73.4%) and primary malignancy ( n  = 328; 15.3%). Laparoscopy was performed in 513 (33.9%) of minor and 37 (6.1%) of major liver resections and increased over time to 39.1% of minor resections in 2016. Median a-LoS was 12 days for major resections, 8 days for open minor and 3 days for laparoscopic minor resections. Reoperation was reported for 159 (7.4%) and 90-day mortality for 44 (2.1%). Primary malignancy, male gender, elderly patients and major resections were associated with poorer outcome. Conclusions In a national cohort, laparoscopy is used for a substantial proportion of minor resections and was associated with reduced a-LoS. Risk factors for reoperation and mortality were male gender, increased age and major resection for primary malignancy.