Risk-stratified posthepatectomy pathways based upon the Kawaguchi–Gayet complexity classification and impact on length of stay

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

Surgery Open Science (Jul 2022)

Risk-stratified posthepatectomy pathways based upon the Kawaguchi–Gayet complexity classification and impact on length of stay

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

Affiliations

Bradford J. Kim, MD, MHS: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Elsa M. Arvide, MS PA-C: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Cameron Gaskill, MD, MPH: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Allison N. Martin, MD, MPH: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Yoshikuni Kawaguchi, MD, PhD: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
Yi-Ju Chiang, MSPH: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Whitney L. Dewhurst, MS NP-C: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Teresa L. Phan, MSN, FNP-C: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Hop S. Tran Cao, MD: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Yun Shin Chun, MD: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Matthew H.G. Katz, MD: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Jean Nicolas Vauthey, MD: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Ching-Wei D. Tzeng, MD: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Timothy E. Newhook, MD: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Corresponding author at: University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, 1400 Pressler St, Unit 1484, Houston, TX 77030. Tel.: +1 (713) 794-1001; fax: +1 (713) 745-5235.

Journal volume & issue: Vol. 9
pp. 109 – 116

Abstract

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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.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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