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Conclusions

Analysis of Right Hepatectomies in the NSQIP Database Determines Benchmark Morbidity and Mortality Rates for Living Related Liver Transplant Donors Aloia TA, Jones S, Haykal N, Michel D, Moore LW, Duchini A, Galati J, Bass BL, Gaber AO, Ghobrial RM

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Conclusions

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  1. Analysis of Right Hepatectomies in the NSQIP Database Determines Benchmark Morbidity and Mortality Rates for Living Related Liver Transplant Donors Aloia TA, Jones S, Haykal N, Michel D, Moore LW, Duchini A, Galati J, Bass BL, Gaber AO, Ghobrial RM Center for Liver Disease and Transplantation, Department of Surgery, The Methodist Hospital, Houston, TX Background Results Conclusions In the US, acceptance of living related liver transplantation (LDLT) has been impeded by an inability to provide the public with donor risk benchmarks. The multi-institutional National Surgical Quality Improvement Program (NSQIP) provides a unique opportunity to identify preoperative risk factors for living donor hepatectomy and to establish objective morbidity and mortality rates for this procedure. The median age of study patients was 49 years, with an equivalent sex distribution. The overall 30-day mortality rate was 2.3% (9/388) and the 30-day major morbidity (MM) rate was 24.5% (95/388). Multivariate analysis identified serum albumin<4.0 gm/dL and alkaline phosphatase >80 gm/dL as the only independent preoperative risk factors for death (p<0.01). Risk factors associated with MM included serum bilirubin>1.2 gm/dL and WBC>10 (p<0.01). For those patients who developed MM, the median length of stay was longer (10 vs 6 days, p=0.001) and the mortality rate was higher (8.4% vs 0.3%, p=0.001). Analysis of the multi-institutional NSQIP experience indicates that the current mortality and major morbidity rate benchmarks for right hepatectomy are 2.3% and 24.5%, respectively. Poor outcomes were associated with nutritional status and abnormal liver laboratory values. These data should be utilized by LDLT programs to council potential donors on their individual risk profile and to assist with liver donor selection. Methods • Examination of the 2005-2007 NSQIP Participant Use File identified 510 right hepatectomy procedures. • To create a case-matched cohort similar to LDLT, analysis was limited to elective procedures in patients without recent chemotherapy, diabetes or coronary disease (Final N=388). • For each case, 36 perioperative risk factors and 52 postoperative complications were assessed. • Multivariate Cox proportional hazards models were used to identify factors independently associated with poor outcome.

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