Abstract：
BACKGROUND: Biliary obstruction before liver resection is a known risk factor for post-operative complications. The aim of this study was to determine the impact of persistent hyperbilirubinemia following preoperative biliary drainage before liver resection.
METHODS: The ACS-NSQIP (2016-2021) database was used to extract patients with cholangiocarcinoma who underwent anatomic liver resection with preoperative biliary drainage comparing those with persistent hyperbilirubinemia (> 1.2 mg/dL) to those with resolution. Patient characteristics and outcomes were compared with bivariate analysis. Multivariable modeling evaluated factors including persistent hyperbilirubinemia to evaluate their independent effect on serious complications, liver failure, and mortality.
RESULTS: We evaluated 463 patients with 217 (46.9%) having hyperbilirubinemia (HB) despite biliary stenting. Bivariate analysis demonstrated that patients with HB had a higher rate of serious complications than those with non-HB (80.7% vs 70.3%; P = 0.010) including bile leak (40.9% vs 31.8%; P = 0.045), liver failure (26.7% vs 17.9%; P = 0.022), and bleeding (48.4% vs 36.6%; P = 0.010). Multivariable analysis demonstrated that persistent HB was independently associated with serious complications (OR 1.88, P = 0.020) and mortality (OR 2.39, P = 0.049) but not post-operative liver failure (OR 1.65, P = 0.082).
CONCLUSIONS: Failed preoperative biliary decompression is a predictive factor for post-operative complications and mortality in patients undergoing hepatectomy and may be useful for preoperative risk stratification.
METHODS: The ACS-NSQIP (2016-2021) database was used to extract patients with cholangiocarcinoma who underwent anatomic liver resection with preoperative biliary drainage comparing those with persistent hyperbilirubinemia (> 1.2 mg/dL) to those with resolution. Patient characteristics and outcomes were compared with bivariate analysis. Multivariable modeling evaluated factors including persistent hyperbilirubinemia to evaluate their independent effect on serious complications, liver failure, and mortality.
RESULTS: We evaluated 463 patients with 217 (46.9%) having hyperbilirubinemia (HB) despite biliary stenting. Bivariate analysis demonstrated that patients with HB had a higher rate of serious complications than those with non-HB (80.7% vs 70.3%; P = 0.010) including bile leak (40.9% vs 31.8%; P = 0.045), liver failure (26.7% vs 17.9%; P = 0.022), and bleeding (48.4% vs 36.6%; P = 0.010). Multivariable analysis demonstrated that persistent HB was independently associated with serious complications (OR 1.88, P = 0.020) and mortality (OR 2.39, P = 0.049) but not post-operative liver failure (OR 1.65, P = 0.082).
CONCLUSIONS: Failed preoperative biliary decompression is a predictive factor for post-operative complications and mortality in patients undergoing hepatectomy and may be useful for preoperative risk stratification.
摘要：
背景：肝切除术前胆道梗阻是术后并发症的已知危险因素。这项研究的目的是确定肝切除术前胆道引流后持续性高胆红素血症的影响。
方法：ACS-NSQIP（2016-2021）数据库用于提取胆管癌患者，这些患者接受解剖性肝切除术并进行术前胆道引流，将持续性高胆红素血症（>1.2mg/dL）的患者与那些有分辨率的患者进行比较。通过双变量分析比较患者特征和结果。多变量模型评估了包括持续性高胆红素血症在内的因素，以评估其对严重并发症的独立影响。肝功能衰竭,和死亡率。
结果：我们评估了463例患者，其中217例（46.9％）患有高胆红素血症（HB），尽管有胆道支架置入。双变量分析表明，HB患者的严重并发症发生率高于非HB患者（80.7％vs70.3％；P=0.010），包括胆漏（40.9％vs31.8％；P=0.045）。肝功能衰竭（26.7%vs17.9%；P=0.022），出血（48.4%vs36.6%；P=0.010）。多变量分析显示，持续性乙型肝炎与严重并发症（OR1.88，P=0.020）和死亡率（OR2.39，P=0.049）独立相关，但与术后肝功能衰竭无关（OR1.65，P=0.082）。
结论：术前胆道减压失败是肝切除术患者术后并发症和死亡率的预测因素，并可能用于术前风险分层。
方法：ACS-NSQIP（2016-2021）数据库用于提取胆管癌患者，这些患者接受解剖性肝切除术并进行术前胆道引流，将持续性高胆红素血症（>1.2mg/dL）的患者与那些有分辨率的患者进行比较。通过双变量分析比较患者特征和结果。多变量模型评估了包括持续性高胆红素血症在内的因素，以评估其对严重并发症的独立影响。肝功能衰竭,和死亡率。
结果：我们评估了463例患者，其中217例（46.9％）患有高胆红素血症（HB），尽管有胆道支架置入。双变量分析表明，HB患者的严重并发症发生率高于非HB患者（80.7％vs70.3％；P=0.010），包括胆漏（40.9％vs31.8％；P=0.045）。肝功能衰竭（26.7%vs17.9%；P=0.022），出血（48.4%vs36.6%；P=0.010）。多变量分析显示，持续性乙型肝炎与严重并发症（OR1.88，P=0.020）和死亡率（OR2.39，P=0.049）独立相关，但与术后肝功能衰竭无关（OR1.65，P=0.082）。
结论：术前胆道减压失败是肝切除术患者术后并发症和死亡率的预测因素，并可能用于术前风险分层。
