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Increased Morbidity and Mortality After Hepatectomy for Colorectal Liver Metastases in Frail Patients is Largely Driven by Worse Outcomes After Minor Hepatectomy: It’s Not “Just a Wedge”
Background Frailty is associated with postoperative mortality, but its significance after hepatectomy for colorectal liver metastases (CRLM) is poorly defined. This study evaluated the impact of frailty after hepatectomy for CRLM. Methods The study identified 8477 patients in National Surgical Quali...
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| Published in: | Annals of surgical oncology 2022-09, Vol.29 (9), p.5476-5485 |
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| container_issue | 9 |
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| creator | Leigh, Natasha Williams, Gregory A. Strasberg, Steven M. Fields, Ryan C. Hawkins, William G. Hammill, Chet W. Sanford, Dominic E. |
| description | Background
Frailty is associated with postoperative mortality, but its significance after hepatectomy for colorectal liver metastases (CRLM) is poorly defined. This study evaluated the impact of frailty after hepatectomy for CRLM.
Methods
The study identified 8477 patients in National Surgical Quality Improvement Program databases from 2014 to 2019 and stratified them by frailty score using the risk analysis index as very frail (>90th percentile), frail (75th–90th percentile), or non-frail ( |
| doi_str_mv | 10.1245/s10434-022-11830-8 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2667788902</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2667788902</sourcerecordid><originalsourceid>FETCH-LOGICAL-c305t-806480ae8edbfb22aed46ea3e89c641d415d90ceda3555cef966a32864a169c93</originalsourceid><addsrcrecordid>eNp9kc9u1DAQxiMEon_gBTigkbhwCdiO47W5VduWbrVLOYB6jBxnskqVxIvtIOW2r1GpvAvPsk9Sb1NAcECyZM_4982M_SXJK0reUcbz954SnvGUMJZSKjOSyifJIc1jigtJn8YzETJVTOQHyZH3N4TQWUby58lBlucqV5k6TH4ueuNQe6xgZV3ZVE0YQfcPUdDtPjqpAzq4wI0OaILtRqitg7ltrYuxbmHZfI_ACoP2caGHpodzp5sWPuvQYB9ixsNSuzW2I5y6iPdQjnBtnUe4GoKxXVRNfVZNb__q9gEWYbe99fDJBtht7y4HH0DDNVZr3G1_vEie1br1-PJxP06-np99mV-ky6uPi_nJMjXxySGVRHBJNEqsyrpkTGPFBeoMpTKC04rTvFLEYKXj3-QGayWEzpgUXFOhjMqOk7dT3Y2z3wb0oegab7BtdY928AUTYjaTUhEW0Tf_oDd2cH2cLlJKMUYll5FiE2Wc9d5hXWxc02k3FpQUe3-Lyd8i-ls8-FvsRa8fSw9lh9VvyS9DI5BNgI9X_Rrdn97_KXsP-bm15Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2699221848</pqid></control><display><type>article</type><title>Increased Morbidity and Mortality After Hepatectomy for Colorectal Liver Metastases in Frail Patients is Largely Driven by Worse Outcomes After Minor Hepatectomy: It’s Not “Just a Wedge”</title><source>Springer Nature</source><creator>Leigh, Natasha ; Williams, Gregory A. ; Strasberg, Steven M. ; Fields, Ryan C. ; Hawkins, William G. ; Hammill, Chet W. ; Sanford, Dominic E.</creator><creatorcontrib>Leigh, Natasha ; Williams, Gregory A. ; Strasberg, Steven M. ; Fields, Ryan C. ; Hawkins, William G. ; Hammill, Chet W. ; Sanford, Dominic E.</creatorcontrib><description>Background
Frailty is associated with postoperative mortality, but its significance after hepatectomy for colorectal liver metastases (CRLM) is poorly defined. This study evaluated the impact of frailty after hepatectomy for CRLM.
Methods
The study identified 8477 patients in National Surgical Quality Improvement Program databases from 2014 to 2019 and stratified them by frailty score using the risk analysis index as very frail (>90th percentile), frail (75th–90th percentile), or non-frail (< 75th percentile). Multivariate regression models determined the impact of frailty on perioperative outcomes, including by the extent of hepatectomy.
Results
The procedures performed were 2752 major hepatectomies (left hepatectomy, right hepatectomy, trisectionectomy) and 5725 minor hepatectomies (≤2 segments) for 870 (10.3%) very frail, 1680 (19.8%) frail, and 5927 (69.9%) non-frail patients. Postoperatively, the very frail and frail patients experienced more complications (very frail [41.8%], frail [35.1%], non-frail [31.0%]), which resulted in a longer hospital stay (very-frail [5.7 days], frail [5.8 days], non-frail [5.1 days]), a higher 30-day mortality (very-frail [2.2%], frail [1.3%], non-frail [0.5%]), and more discharges to a facility (very frail [6.8%], frail [3.7%], non-frail [2.6%]) (
p
< 0.05) although they underwent similarly extensive (major vs. minor) hepatectomies. In the multivariate analysis, frailty was independently associated with complications (very-frail [odds ratio {OR}, 1.70], frail [OR, 1.25]) and 30-day mortality (very-frail [OR, 4.24], frail [OR, 2.41]) (
p
< 0.05). After minor hepatectomy, the very frail and frail patients had significantly higher rates of complications and 30-day mortality than the non-frail patients, and in the multivariate analysis, frailty was independently associated with complications (very frail [OR, 1.97], frail [OR, 1.27]) and 30-day mortality (very frail [OR, 6.76], frail [OR, 3.47]) (
p
< 0.05) after minor hepatectomy.
Conclusions
Frailty predicted significantly poorer outcomes after hepatectomy for CRLM, even after only a minor hepatectomy.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-022-11830-8</identifier><identifier>PMID: 35595939</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Frailty ; Hepatectomy ; Hepatobiliary Tumors ; Liver ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Morbidity ; Mortality ; Multivariate analysis ; Oncology ; Patients ; Quality control ; Regression analysis ; Surgery ; Surgical Oncology</subject><ispartof>Annals of surgical oncology, 2022-09, Vol.29 (9), p.5476-5485</ispartof><rights>Society of Surgical Oncology 2022</rights><rights>2022. Society of Surgical Oncology.</rights><rights>Society of Surgical Oncology 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c305t-806480ae8edbfb22aed46ea3e89c641d415d90ceda3555cef966a32864a169c93</citedby><cites>FETCH-LOGICAL-c305t-806480ae8edbfb22aed46ea3e89c641d415d90ceda3555cef966a32864a169c93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35595939$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leigh, Natasha</creatorcontrib><creatorcontrib>Williams, Gregory A.</creatorcontrib><creatorcontrib>Strasberg, Steven M.</creatorcontrib><creatorcontrib>Fields, Ryan C.</creatorcontrib><creatorcontrib>Hawkins, William G.</creatorcontrib><creatorcontrib>Hammill, Chet W.</creatorcontrib><creatorcontrib>Sanford, Dominic E.</creatorcontrib><title>Increased Morbidity and Mortality After Hepatectomy for Colorectal Liver Metastases in Frail Patients is Largely Driven by Worse Outcomes After Minor Hepatectomy: It’s Not “Just a Wedge”</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Frailty is associated with postoperative mortality, but its significance after hepatectomy for colorectal liver metastases (CRLM) is poorly defined. This study evaluated the impact of frailty after hepatectomy for CRLM.
Methods
The study identified 8477 patients in National Surgical Quality Improvement Program databases from 2014 to 2019 and stratified them by frailty score using the risk analysis index as very frail (>90th percentile), frail (75th–90th percentile), or non-frail (< 75th percentile). Multivariate regression models determined the impact of frailty on perioperative outcomes, including by the extent of hepatectomy.
Results
The procedures performed were 2752 major hepatectomies (left hepatectomy, right hepatectomy, trisectionectomy) and 5725 minor hepatectomies (≤2 segments) for 870 (10.3%) very frail, 1680 (19.8%) frail, and 5927 (69.9%) non-frail patients. Postoperatively, the very frail and frail patients experienced more complications (very frail [41.8%], frail [35.1%], non-frail [31.0%]), which resulted in a longer hospital stay (very-frail [5.7 days], frail [5.8 days], non-frail [5.1 days]), a higher 30-day mortality (very-frail [2.2%], frail [1.3%], non-frail [0.5%]), and more discharges to a facility (very frail [6.8%], frail [3.7%], non-frail [2.6%]) (
p
< 0.05) although they underwent similarly extensive (major vs. minor) hepatectomies. In the multivariate analysis, frailty was independently associated with complications (very-frail [odds ratio {OR}, 1.70], frail [OR, 1.25]) and 30-day mortality (very-frail [OR, 4.24], frail [OR, 2.41]) (
p
< 0.05). After minor hepatectomy, the very frail and frail patients had significantly higher rates of complications and 30-day mortality than the non-frail patients, and in the multivariate analysis, frailty was independently associated with complications (very frail [OR, 1.97], frail [OR, 1.27]) and 30-day mortality (very frail [OR, 6.76], frail [OR, 3.47]) (
p
< 0.05) after minor hepatectomy.
Conclusions
Frailty predicted significantly poorer outcomes after hepatectomy for CRLM, even after only a minor hepatectomy.</description><subject>Frailty</subject><subject>Hepatectomy</subject><subject>Hepatobiliary Tumors</subject><subject>Liver</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Oncology</subject><subject>Patients</subject><subject>Quality control</subject><subject>Regression analysis</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kc9u1DAQxiMEon_gBTigkbhwCdiO47W5VduWbrVLOYB6jBxnskqVxIvtIOW2r1GpvAvPsk9Sb1NAcECyZM_4982M_SXJK0reUcbz954SnvGUMJZSKjOSyifJIc1jigtJn8YzETJVTOQHyZH3N4TQWUby58lBlucqV5k6TH4ueuNQe6xgZV3ZVE0YQfcPUdDtPjqpAzq4wI0OaILtRqitg7ltrYuxbmHZfI_ACoP2caGHpodzp5sWPuvQYB9ixsNSuzW2I5y6iPdQjnBtnUe4GoKxXVRNfVZNb__q9gEWYbe99fDJBtht7y4HH0DDNVZr3G1_vEie1br1-PJxP06-np99mV-ky6uPi_nJMjXxySGVRHBJNEqsyrpkTGPFBeoMpTKC04rTvFLEYKXj3-QGayWEzpgUXFOhjMqOk7dT3Y2z3wb0oegab7BtdY928AUTYjaTUhEW0Tf_oDd2cH2cLlJKMUYll5FiE2Wc9d5hXWxc02k3FpQUe3-Lyd8i-ls8-FvsRa8fSw9lh9VvyS9DI5BNgI9X_Rrdn97_KXsP-bm15Q</recordid><startdate>20220901</startdate><enddate>20220901</enddate><creator>Leigh, Natasha</creator><creator>Williams, Gregory A.</creator><creator>Strasberg, Steven M.</creator><creator>Fields, Ryan C.</creator><creator>Hawkins, William G.</creator><creator>Hammill, Chet W.</creator><creator>Sanford, Dominic E.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20220901</creationdate><title>Increased Morbidity and Mortality After Hepatectomy for Colorectal Liver Metastases in Frail Patients is Largely Driven by Worse Outcomes After Minor Hepatectomy: It’s Not “Just a Wedge”</title><author>Leigh, Natasha ; Williams, Gregory A. ; Strasberg, Steven M. ; Fields, Ryan C. ; Hawkins, William G. ; Hammill, Chet W. ; Sanford, Dominic E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-806480ae8edbfb22aed46ea3e89c641d415d90ceda3555cef966a32864a169c93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Frailty</topic><topic>Hepatectomy</topic><topic>Hepatobiliary Tumors</topic><topic>Liver</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Oncology</topic><topic>Patients</topic><topic>Quality control</topic><topic>Regression analysis</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leigh, Natasha</creatorcontrib><creatorcontrib>Williams, Gregory A.</creatorcontrib><creatorcontrib>Strasberg, Steven M.</creatorcontrib><creatorcontrib>Fields, Ryan C.</creatorcontrib><creatorcontrib>Hawkins, William G.</creatorcontrib><creatorcontrib>Hammill, Chet W.</creatorcontrib><creatorcontrib>Sanford, Dominic E.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leigh, Natasha</au><au>Williams, Gregory A.</au><au>Strasberg, Steven M.</au><au>Fields, Ryan C.</au><au>Hawkins, William G.</au><au>Hammill, Chet W.</au><au>Sanford, Dominic E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased Morbidity and Mortality After Hepatectomy for Colorectal Liver Metastases in Frail Patients is Largely Driven by Worse Outcomes After Minor Hepatectomy: It’s Not “Just a Wedge”</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2022-09-01</date><risdate>2022</risdate><volume>29</volume><issue>9</issue><spage>5476</spage><epage>5485</epage><pages>5476-5485</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Frailty is associated with postoperative mortality, but its significance after hepatectomy for colorectal liver metastases (CRLM) is poorly defined. This study evaluated the impact of frailty after hepatectomy for CRLM.
Methods
The study identified 8477 patients in National Surgical Quality Improvement Program databases from 2014 to 2019 and stratified them by frailty score using the risk analysis index as very frail (>90th percentile), frail (75th–90th percentile), or non-frail (< 75th percentile). Multivariate regression models determined the impact of frailty on perioperative outcomes, including by the extent of hepatectomy.
Results
The procedures performed were 2752 major hepatectomies (left hepatectomy, right hepatectomy, trisectionectomy) and 5725 minor hepatectomies (≤2 segments) for 870 (10.3%) very frail, 1680 (19.8%) frail, and 5927 (69.9%) non-frail patients. Postoperatively, the very frail and frail patients experienced more complications (very frail [41.8%], frail [35.1%], non-frail [31.0%]), which resulted in a longer hospital stay (very-frail [5.7 days], frail [5.8 days], non-frail [5.1 days]), a higher 30-day mortality (very-frail [2.2%], frail [1.3%], non-frail [0.5%]), and more discharges to a facility (very frail [6.8%], frail [3.7%], non-frail [2.6%]) (
p
< 0.05) although they underwent similarly extensive (major vs. minor) hepatectomies. In the multivariate analysis, frailty was independently associated with complications (very-frail [odds ratio {OR}, 1.70], frail [OR, 1.25]) and 30-day mortality (very-frail [OR, 4.24], frail [OR, 2.41]) (
p
< 0.05). After minor hepatectomy, the very frail and frail patients had significantly higher rates of complications and 30-day mortality than the non-frail patients, and in the multivariate analysis, frailty was independently associated with complications (very frail [OR, 1.97], frail [OR, 1.27]) and 30-day mortality (very frail [OR, 6.76], frail [OR, 3.47]) (
p
< 0.05) after minor hepatectomy.
Conclusions
Frailty predicted significantly poorer outcomes after hepatectomy for CRLM, even after only a minor hepatectomy.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>35595939</pmid><doi>10.1245/s10434-022-11830-8</doi><tpages>10</tpages></addata></record> |
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| ispartof | Annals of surgical oncology, 2022-09, Vol.29 (9), p.5476-5485 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | Springer Nature |
| subjects | Frailty Hepatectomy Hepatobiliary Tumors Liver Medicine Medicine & Public Health Metastases Metastasis Morbidity Mortality Multivariate analysis Oncology Patients Quality control Regression analysis Surgery Surgical Oncology |
| title | Increased Morbidity and Mortality After Hepatectomy for Colorectal Liver Metastases in Frail Patients is Largely Driven by Worse Outcomes After Minor Hepatectomy: It’s Not “Just a Wedge” |
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