Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy

Q. Lina Hu, Jason B. Liu, Ryan J. Ellis, Jessica Y. Liu, Anthony D. Yang, Michael I. D'Angelica, Clifford Y. Ko, Ryan P. Merkow*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Endoscopic biliary stenting (EBS) and percutaneous transhepatic biliary drainage (PTBD) are two techniques used for preoperative biliary drainage prior to hepatobiliary resection. The objectives of this study were to determine predictors of the drainage technique selection and to evaluate the association between drainage technique and postoperative outcomes. Methods: Using ACS NSQIP data (2014–2017), patients who underwent preoperative biliary drainage prior to hepatobiliary resection for malignancy were identified. Separate multivariable-adjusted, propensity score (PS) adjusted, and PS matched logistic regression models were constructed to evaluate the association between drainage technique and postoperative outcomes. Results: Of 527 patients identified, 431 (81.8%) received EBS and 96 (18.2%) received PTBD. Patients who underwent PTBD had more preoperative co-morbidities, including higher ASA class, recent weight loss, and hypoalbuminemia (all p < 0.05). After multivariable adjustment, PTBD was significantly associated with 30-day DSM (OR 1.92, 95% CI 1.24–2.97, p = 0.004), overall SSI (OR 1.74, 95% CI 1.10–2.76, p = 0.019), and superficial SSI (OR 2.08, 95% CI 1.20–3.60, p = 0.010). These findings remained significant for both PS-adjusted and PS-matched models. Conclusion: Patients undergoing hepatobiliary resection selected for PTBD had significantly more preoperative co-morbidities and nutritional deficits. Compared to EBS, PTBD was associated with significantly higher odds of postoperative morbidity and mortality.

Original languageEnglish (US)
JournalHPB
DOIs
StatePublished - Jan 1 2019

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Drainage
Propensity Score
Neoplasms
Morbidity
Logistic Models
Hypoalbuminemia
Weight Loss
Mortality

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Hu, Q. Lina ; Liu, Jason B. ; Ellis, Ryan J. ; Liu, Jessica Y. ; Yang, Anthony D. ; D'Angelica, Michael I. ; Ko, Clifford Y. ; Merkow, Ryan P. / Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy. In: HPB. 2019.
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title = "Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy",
abstract = "Background: Endoscopic biliary stenting (EBS) and percutaneous transhepatic biliary drainage (PTBD) are two techniques used for preoperative biliary drainage prior to hepatobiliary resection. The objectives of this study were to determine predictors of the drainage technique selection and to evaluate the association between drainage technique and postoperative outcomes. Methods: Using ACS NSQIP data (2014–2017), patients who underwent preoperative biliary drainage prior to hepatobiliary resection for malignancy were identified. Separate multivariable-adjusted, propensity score (PS) adjusted, and PS matched logistic regression models were constructed to evaluate the association between drainage technique and postoperative outcomes. Results: Of 527 patients identified, 431 (81.8{\%}) received EBS and 96 (18.2{\%}) received PTBD. Patients who underwent PTBD had more preoperative co-morbidities, including higher ASA class, recent weight loss, and hypoalbuminemia (all p < 0.05). After multivariable adjustment, PTBD was significantly associated with 30-day DSM (OR 1.92, 95{\%} CI 1.24–2.97, p = 0.004), overall SSI (OR 1.74, 95{\%} CI 1.10–2.76, p = 0.019), and superficial SSI (OR 2.08, 95{\%} CI 1.20–3.60, p = 0.010). These findings remained significant for both PS-adjusted and PS-matched models. Conclusion: Patients undergoing hepatobiliary resection selected for PTBD had significantly more preoperative co-morbidities and nutritional deficits. Compared to EBS, PTBD was associated with significantly higher odds of postoperative morbidity and mortality.",
author = "Hu, {Q. Lina} and Liu, {Jason B.} and Ellis, {Ryan J.} and Liu, {Jessica Y.} and Yang, {Anthony D.} and D'Angelica, {Michael I.} and Ko, {Clifford Y.} and Merkow, {Ryan P.}",
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Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy. / Hu, Q. Lina; Liu, Jason B.; Ellis, Ryan J.; Liu, Jessica Y.; Yang, Anthony D.; D'Angelica, Michael I.; Ko, Clifford Y.; Merkow, Ryan P.

In: HPB, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy

AU - Hu, Q. Lina

AU - Liu, Jason B.

AU - Ellis, Ryan J.

AU - Liu, Jessica Y.

AU - Yang, Anthony D.

AU - D'Angelica, Michael I.

AU - Ko, Clifford Y.

AU - Merkow, Ryan P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Endoscopic biliary stenting (EBS) and percutaneous transhepatic biliary drainage (PTBD) are two techniques used for preoperative biliary drainage prior to hepatobiliary resection. The objectives of this study were to determine predictors of the drainage technique selection and to evaluate the association between drainage technique and postoperative outcomes. Methods: Using ACS NSQIP data (2014–2017), patients who underwent preoperative biliary drainage prior to hepatobiliary resection for malignancy were identified. Separate multivariable-adjusted, propensity score (PS) adjusted, and PS matched logistic regression models were constructed to evaluate the association between drainage technique and postoperative outcomes. Results: Of 527 patients identified, 431 (81.8%) received EBS and 96 (18.2%) received PTBD. Patients who underwent PTBD had more preoperative co-morbidities, including higher ASA class, recent weight loss, and hypoalbuminemia (all p < 0.05). After multivariable adjustment, PTBD was significantly associated with 30-day DSM (OR 1.92, 95% CI 1.24–2.97, p = 0.004), overall SSI (OR 1.74, 95% CI 1.10–2.76, p = 0.019), and superficial SSI (OR 2.08, 95% CI 1.20–3.60, p = 0.010). These findings remained significant for both PS-adjusted and PS-matched models. Conclusion: Patients undergoing hepatobiliary resection selected for PTBD had significantly more preoperative co-morbidities and nutritional deficits. Compared to EBS, PTBD was associated with significantly higher odds of postoperative morbidity and mortality.

AB - Background: Endoscopic biliary stenting (EBS) and percutaneous transhepatic biliary drainage (PTBD) are two techniques used for preoperative biliary drainage prior to hepatobiliary resection. The objectives of this study were to determine predictors of the drainage technique selection and to evaluate the association between drainage technique and postoperative outcomes. Methods: Using ACS NSQIP data (2014–2017), patients who underwent preoperative biliary drainage prior to hepatobiliary resection for malignancy were identified. Separate multivariable-adjusted, propensity score (PS) adjusted, and PS matched logistic regression models were constructed to evaluate the association between drainage technique and postoperative outcomes. Results: Of 527 patients identified, 431 (81.8%) received EBS and 96 (18.2%) received PTBD. Patients who underwent PTBD had more preoperative co-morbidities, including higher ASA class, recent weight loss, and hypoalbuminemia (all p < 0.05). After multivariable adjustment, PTBD was significantly associated with 30-day DSM (OR 1.92, 95% CI 1.24–2.97, p = 0.004), overall SSI (OR 1.74, 95% CI 1.10–2.76, p = 0.019), and superficial SSI (OR 2.08, 95% CI 1.20–3.60, p = 0.010). These findings remained significant for both PS-adjusted and PS-matched models. Conclusion: Patients undergoing hepatobiliary resection selected for PTBD had significantly more preoperative co-morbidities and nutritional deficits. Compared to EBS, PTBD was associated with significantly higher odds of postoperative morbidity and mortality.

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DO - 10.1016/j.hpb.2019.06.011

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