ArticleAnnals of surgery2020
Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707 Consecutive Hepatectomies.
Article in Annals of surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 2 of them syntheses that pooled it.
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Who cites it
52 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis.Surgical endoscopy · 2022Pooled it
- Article
- Redefining Clavien-Dindo Classification in MBSAQIP: Laparoscopic Vs. Robotic Sleeve Gastrectomy.Obesity surgery · 2026Article
- Safety and efficacy of HLBLS-200 (BleeFix) as a novel hemostatic agent in hepatic surgery: a multicenter, randomized, active-controlled clinical trial.Annals of surgical treatment and research · 2026Article
- Article
- Nonoperative Management of Hepatic Adenomas: A Review.Journal of gastrointestinal cancer · 2026Review
- Risk Factors and Strategies for Failure to Rescue Following Hepatectomy: A Review.Journal of hepato-biliary-pancreatic sciences · 2025Review
- Evaluating Laparoscopic and Robotic Liver Resection in Elderly Patients: A NSQIP Analysis of Short-Term Outcomes.Journal of surgical oncology · 2025Article
- Improving surgical outcome reporting in lithiasis surgery: a comparative analysis of comprehensive complication index and clavien-dindo classification.The Canadian journal of urology · 2025Article
- Simple definition of biologically borderline resectable colorectal liver metastases based on early surgical failure.International journal of clinical oncology · 2025Article
- Standardized reporting of intrahepatic cholangiocarcinoma.Abdominal radiology (New York) · 2025Review
- Evolution of Liver Resection for Hepatocellular Carcinoma: Change Point Analysis of Textbook Outcome over Twenty Years.Medicina (Kaunas, Lithuania) · 2024Article
- Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery.World journal of gastrointestinal surgery · 2024Article
- Laparoscopic versus open hepatic resection in patients ≥75 years old: A NSQIP analysis evaluating 2674 patients.Journal of surgical oncology · 2024Article
- Metabolic dysfunction-associated fatty liver disease increases the risk of complications after radical resection in patients with hepatocellular carcinoma.World journal of surgical oncology · 2024Article
- Current and future applications of artificial intelligence in surgery: implications for clinical practice and research.Frontiers in surgery · 2024Review
- Article
- A systematic review and meta-analysis of blood transfusion rates during liver resection by country.Annals of surgical treatment and research · 2023Article
- A virtual biopsy of liver parenchyma to predict the outcome of liver resection.Updates in surgery · 2023Article
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15 authors.
Funding
Abstract
objectiveThe aim of this study was to evaluate trends over time in perioperative outcomes for patients undergoing hepatectomy.
backgroundAs perioperative care and surgical technique for hepatectomy have improved, the indications for and complexity of liver resections have evolved. However, the resulting effect on the short-term outcomes over time has not been well described.
methodsConsecutive patients undergoing hepatectomy during 1998 to 2015 at 1 institution were analyzed. Perioperative outcomes, including the comprehensive complication index (CCI), were compared between patients who underwent hepatectomy in the eras 1998 to 2003, 2004 to 2009, and 2010 to 2015.
resultsThe study included 3707 hepatic resections. The number of hepatectomies increased in each era (794 in 1998 to 2003, 1402 in 2004 to 2009, and 1511 in 2010 to 2015). Technical complexity increased over time as evidenced by increases in the rates of major hepatectomy (20%, 23%, 30%, P < 0.0001), 2-stage hepatectomy (0%, 3%, 4%, P < 0.001), need for portal vein embolization (5%, 9%, 9%, P = 0.001), preoperative chemotherapy for colorectal liver metastases (70%, 82%, 89%, P < 0.001) and median operative time (180, 175, 225 minutes, P < 0.001). Significant decreases over time were observed in median blood loss (300, 250, 200 mL, P < 0.001), transfusion rate (19%, 15%, 5%, P < 0.001), median length of hospitalization (7, 7, 6 days, P < 0.001), rates of CCI ≥26.2 (20%, 22%, 16%, P < 0.001) and 90-day mortality (3.1%, 2.6%, 1.3%, P < 0.01). On multivariable analysis, hepatectomy in the most recent era 2010 to 2015 was associated with a lower incidence of CCI ≥26.2 (odds ratio 0.7, 95% confidence interval 0.6-0.8, P < 0.0001).
conclusionDespite increases in complexity over an 18-year period, continued improvements in surgical technique and perioperative outcomes yielded a resultant decrease in CCI in the most current era.
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