One-Year Mortality after Hepatectomy: Defining a Novel Quality Metric.

Abstract

Owing to better technique and perioperative care, 30- and 90-day mortality after hepatectomy has improved. However, little is known about survival in the first year after hepatectomy. Patients (age > 18) who underwent hepatectomy for any indication between 1991-2018 at a single institution were identified. Univariable and multivariable logistic regression were used to assess the relationship between clinical factors and death within 1 year for all patients and for patients who underwent hepatectomy for colorectal liver metastases (CRLM). This study included 6191 patients, of which 54% had CRLM. The 1-year survival was 89.9% (95%CI:89.1-90.7%). For patients who survived to 90 days, the probability of survival until 1 year was 92.2% (95%CI:91.9-92.5%). Malignancy had the strongest association with 1-year mortality (11% versus 2%, OR:5.82, 95%CI:2.13-15.88, p < 0.001), followed by major complications (22% versus 7%, OR:2.84, 95%CI:2.31-3.49, p < 0.001) and open approach (11% versus 3%, OR:2.06, 95%CI:1.06-3.98, p = 0.032). In the CRLM subset, the 1-year death rate was 7.6% (95%CI:6.7-8.6%). Major complications (17% versus 5%, OR:2.94, 95%CI:2.10-4.12, p < 0.001), 1-year recurrence (11% versus 5%, OR:2.78, 95%CI:1.97-3.91, p < 0.001), 4+ liver lesions (12% versus 7%, OR:2.12, 95%CI:1.46-3.09, p < 0.001) and hepatitis B/C (20% versus 7%, OR:3.47, 95%CI:1.31-9.16, p = 0.012) were associated with death at 1 year for this subset. The 1-year mortality after hepatectomy is substantial, with 1 out of 10 patients dying within 1 year of surgery. Unlike the 30- and 90-day mortality, which capture technical or perioperative causes of death, 1-year mortality may serve as a more comprehensive postoperative outcome, by more broadly capturing postsurgical events and disease progression.