Association Between Operative Approach and Venous Thromboembolism Rate Following Hepatectomy: a Propensity-Matched Analy
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ORIGINAL ARTICLE
Association Between Operative Approach and Venous Thromboembolism Rate Following Hepatectomy: a Propensity-Matched Analysis Jonathan J. Hue 1 & Erryk Katayama 2 & Sarah C. Markt 3 & Luke D. Rothermel 1 & Jeffrey M. Hardacre 1 & John B. Ammori 1 & Jordan M. Winter 1 & Lee M. Ocuin 4 Received: 9 September 2020 / Accepted: 16 November 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background The use of minimally invasive approaches to hepatectomy has increased in recent years, but the risk of postoperative venous thromboembolism (VTE) is undefined. We aimed to compare VTE rates after open hepatectomy and minimally invasive hepatectomy using an administrative dataset. Study Design Patients with primary or metastatic liver tumors were identified in the National Surgical Quality Improvement Program-targeted hepatectomy database (2016–2018). VTE was compared between patients who underwent open or minimally invasive hepatectomy after a propensity score matching of 1:1 for demographics, comorbidities, and operative factors. Results A total of 6935 patients underwent open hepatectomy and 2237 underwent minimally invasive hepatectomy. After matching, there were 1968 patients per group without differences in demographics, comorbidities, or operative variables. Prior to matching, the VTE rate was higher among patients who underwent open hepatectomy (2.8% vs. 1.1%, p < 0.001), and open hepatectomy was independently associated with VTE (OR = 1.90, p = 0.006). The VTE rate remained higher among open hepatectomy compared to minimally invasive hepatectomy after matching (2.4% vs. 1.1%, p = 0.003). Open hepatectomy was associated with a higher VTE rate in patients undergoing minor (1.9 vs. 1.0%, p = 0.028) and major hepatectomy (5.0 vs. 1.9%, p = 0.045). Conclusion Patients who undergo an open hepatectomy for malignancy have a higher incidence of postoperative VTE compared to minimally invasive hepatectomy for both minor and major hepatectomy. Keywords Liver cancer . Hepatectomy . Deep vein thrombosis . Pulmonary embolism . Venous thromboembolism
Introduction Hepatectomy is an important treatment modality for patients with resectable primary liver cancers and many with * Lee M. Ocuin [email protected] 1
Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
2
Case Western Reserve University, Cleveland, OH, USA
3
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
4
Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Atrium Health Cabarrus, 200 Medical Park Drive, Suite 430, Concord, NC 28025, USA
1
metastatic tumors. ,2 Relevant pathologies include hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and resectable metastases originating from colorectal or neuroendocrine primary tumors. Postoperative venous thromboembolism (VTE) describes occlusive disease of the deep or central veins and includes deep vein throm
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