Simultaneous diaphragm and liver resection

A propensity-matched analysis of postoperative morbidity

George Z. Li, Jason L. Sloane, Michael E. Lidsky, Georgia M. Beasley, Srinevas K. Reddy, John E. Scarborough, Douglas Tyler, Ryan S. Turley, Bryan M. Clary

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Although a concomitant diaphragm resection might be required at the time of hepatectomy to achieve tumor-free surgical margins, studies addressing its effect on postoperative morbidity and mortality have been inconclusive. The objective of this study was to determine whether the need for diaphragm resection at the time of hepatectomy truly increases 30-day morbidity or mortality using data from the American College of Surgeons National Surgical Quality Improvement Program. Study Design: Data were obtained from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program Participant User Files based on CPT coding. All patients undergoing a simultaneous liver and diaphragm resection were propensity-matched to a subset of liver resection patients not undergoing a diaphragm resection. The main outcomes measures were 30-day mortality and morbidity. Results: One hundred and ninety-two patients who underwent combined liver and diaphragm resection were matched to 192 patients treated with liver resection alone. The need for concomitant diaphragm resection was associated with a higher overall complication rate (38.54% vs 28.65%; p = 0.048), major complication rate (33.33% vs 23.44%; p = 0.030), and respiratory complication rate (14.06% vs 7.81%; p = 0.058). Postoperative mortality was similar between groups. Combined diaphragm and liver resection was also associated with longer operative times (median 311 minutes vs 247.5 minutes; p < 0.001), higher rates of intraoperative packed RBC transfusion (33.33% vs 23.44%; p = 0.037), and a longer length of hospitalization (median 7 vs 6 days; p = 0.002). Conclusions: The results of this study, when taken into account with those reported previously, suggest that the need for diaphragm resection at time of hepatectomy increases postoperative morbidity but not mortality.

Original languageEnglish (US)
Pages (from-to)402-411
Number of pages10
JournalJournal of the American College of Surgeons
Volume216
Issue number3
DOIs
StatePublished - Mar 2013
Externally publishedYes

Fingerprint

Diaphragm
Morbidity
Liver
Hepatectomy
Mortality
Quality Improvement
Operative Time
Respiratory Rate
Hospitalization
Outcome Assessment (Health Care)

Keywords

  • diaphragm resection
  • DR
  • liver resection
  • LR
  • National Surgical Quality Improvement Program
  • NSQIP
  • relative value unit
  • RVU
  • SSI
  • surgical site infection

ASJC Scopus subject areas

  • Surgery

Cite this

Li, G. Z., Sloane, J. L., Lidsky, M. E., Beasley, G. M., Reddy, S. K., Scarborough, J. E., ... Clary, B. M. (2013). Simultaneous diaphragm and liver resection: A propensity-matched analysis of postoperative morbidity. Journal of the American College of Surgeons, 216(3), 402-411. https://doi.org/10.1016/j.jamcollsurg.2012.11.001

Simultaneous diaphragm and liver resection : A propensity-matched analysis of postoperative morbidity. / Li, George Z.; Sloane, Jason L.; Lidsky, Michael E.; Beasley, Georgia M.; Reddy, Srinevas K.; Scarborough, John E.; Tyler, Douglas; Turley, Ryan S.; Clary, Bryan M.

In: Journal of the American College of Surgeons, Vol. 216, No. 3, 03.2013, p. 402-411.

Research output: Contribution to journalArticle

Li, GZ, Sloane, JL, Lidsky, ME, Beasley, GM, Reddy, SK, Scarborough, JE, Tyler, D, Turley, RS & Clary, BM 2013, 'Simultaneous diaphragm and liver resection: A propensity-matched analysis of postoperative morbidity', Journal of the American College of Surgeons, vol. 216, no. 3, pp. 402-411. https://doi.org/10.1016/j.jamcollsurg.2012.11.001
Li, George Z. ; Sloane, Jason L. ; Lidsky, Michael E. ; Beasley, Georgia M. ; Reddy, Srinevas K. ; Scarborough, John E. ; Tyler, Douglas ; Turley, Ryan S. ; Clary, Bryan M. / Simultaneous diaphragm and liver resection : A propensity-matched analysis of postoperative morbidity. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 3. pp. 402-411.
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abstract = "Background: Although a concomitant diaphragm resection might be required at the time of hepatectomy to achieve tumor-free surgical margins, studies addressing its effect on postoperative morbidity and mortality have been inconclusive. The objective of this study was to determine whether the need for diaphragm resection at the time of hepatectomy truly increases 30-day morbidity or mortality using data from the American College of Surgeons National Surgical Quality Improvement Program. Study Design: Data were obtained from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program Participant User Files based on CPT coding. All patients undergoing a simultaneous liver and diaphragm resection were propensity-matched to a subset of liver resection patients not undergoing a diaphragm resection. The main outcomes measures were 30-day mortality and morbidity. Results: One hundred and ninety-two patients who underwent combined liver and diaphragm resection were matched to 192 patients treated with liver resection alone. The need for concomitant diaphragm resection was associated with a higher overall complication rate (38.54{\%} vs 28.65{\%}; p = 0.048), major complication rate (33.33{\%} vs 23.44{\%}; p = 0.030), and respiratory complication rate (14.06{\%} vs 7.81{\%}; p = 0.058). Postoperative mortality was similar between groups. Combined diaphragm and liver resection was also associated with longer operative times (median 311 minutes vs 247.5 minutes; p < 0.001), higher rates of intraoperative packed RBC transfusion (33.33{\%} vs 23.44{\%}; p = 0.037), and a longer length of hospitalization (median 7 vs 6 days; p = 0.002). Conclusions: The results of this study, when taken into account with those reported previously, suggest that the need for diaphragm resection at time of hepatectomy increases postoperative morbidity but not mortality.",
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