التفاصيل البيبلوغرافية
| العنوان: |
Risk-stratified posthepatectomy pathways based upon the Kawaguchi–Gayet complexity classification and impact on length of stay |
| المؤلفون: |
Bradford J. Kim, MD, MHS, Elsa M. Arvide, MS PA-C, Cameron Gaskill, MD, MPH, Allison N. Martin, MD, MPH, Yoshikuni Kawaguchi, MD, PhD, Yi-Ju Chiang, MSPH, Whitney L. Dewhurst, MS NP-C, Teresa L. Phan, MSN, FNP-C, Hop S. Tran Cao, MD, Yun Shin Chun, MD, Matthew H.G. Katz, MD, Jean Nicolas Vauthey, MD, Ching-Wei D. Tzeng, MD, Timothy E. Newhook, MD |
| المصدر: |
Surgery Open Science, Vol 9, Iss , Pp 109-116 (2022) |
| بيانات النشر: |
Elsevier, 2022. |
| سنة النشر: |
2022 |
| المجموعة: |
LCC:Surgery |
| مصطلحات موضوعية: |
Surgery, RD1-811 |
| الوصف: |
Background: The Kawaguchi–Gayet classification is a validated system to stratify open liver resections by complexity and postoperative complications. We hypothesized that Kawaguchi–Gayet classification could be used to create and implement risk-stratified posthepatectomy pathways to reduce length of stay and variation in care. Methods: Clinicopathologic data from hepatectomy patients (1/2017–6/2020) were abstracted from a prospective database. All open hepatectomies were assigned to groups based on 2 levels of Kawaguchi–Gayet classification, and corresponding risk-stratified posthepatectomy pathways were created to decrease length of stay by 1day compared to patients who were historically treated without a pathway: low–intermediate risk (open Kawaguchi–Gayet I/II) and high risk (open Kawaguchi–Gayet III). Outcomes were compared between periods before (''PRE''; 1/1/2017–9/30/2019) and after (''POST''; 10/1/2019–6/30/2020) implementation. Results: Among 487 open hepatectomies (PRE: 374, POST: 113), 55.0% (n=268) were low–intermediate risk and 45.0% (n=219) were high risk. Major complications were similar PRE/POST: low–intermediate risk (PRE: 7.8%, POST: 9.4%, P=.681) and high risk (PRE: 18.9%, POST 10.0%, P=0.139). Risk-stratified posthepatectomy pathway implementation reduced median length of stay for both low–intermediate risk (4 to 3.5days, P=.009) and high risk (5 to 4days, P=0.022) patients. Risk-stratified posthepatectomy pathways decreased length of stay variation, reflected in mean and standard deviation for all patients (PRE 5.5±7.5 vs POST 4.4±2.8days). There was no difference in 90-day readmission rates between PRE (12.6%) and POST (8.8%) periods (P=.278). Conclusion: The creation and implementation of risk-stratified posthepatectomy pathways reduced length of stay without increasing readmissions after hepatectomy. These generalizable risk-stratified posthepatectomy pathways preoperatively stratify patients a priori into pathways for individualized preoperative discussions on realistic postoperative complications and length of stay expectations. |
| نوع الوثيقة: |
article |
| وصف الملف: |
electronic resource |
| اللغة: |
English |
| تدمد: |
2589-8450 |
| Relation: |
http://www.sciencedirect.com/science/article/pii/S2589845022000239; https://doaj.org/toc/2589-8450 |
| DOI: |
10.1016/j.sopen.2022.04.006 |
| URL الوصول: |
https://doaj.org/article/9e57111c143c43f88b1146101398e8c3 |
| رقم الانضمام: |
edsdoj.9e57111c143c43f88b1146101398e8c3 |
| قاعدة البيانات: |
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