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- W2891692012 abstract "Background: Improvements in preoperative risk calculators have enhanced the accuracy for estimating postoperative events. However, there remains a subset of patients that incur perioperative mortality despite extremely low predicted preoperative risk. The objective of this study was to characterize postoperative trajectories of patients with low estimated preoperative risk that died following major hepatobiliary surgery. Methods: The ACS NSQIP PUF 2006–2012 was queried. Patients undergoing major hepatobiliary surgery were identified using CPT codes. Very low risk patients were defined by having a predicted risk of mortality in the lowest quartile for each included CPT. Propensity score matching was used to compare very low risk patients that died to those that survived. Decision tree analysis measured the contribution of individual postoperative complications to postoperative mortality. Results: 63,643 patients underwent hepatobiliary procedures and 10,305 were defined as very low risk patients. Of these, 68 patients (0.7%) died. When compared to propensity-matched patients, they were more likely to develop postoperative organ space SSI, pneumonia, unplanned intubation, ventilation for >48 hours, progressive renal insufficiency, acute renal failure, cardiac arrest, myocardial infarction, bleeding transfusions, septic shock, and unplanned return to OR (all p<0.05). The complications most strongly predictive of mortality were ventilator >48 hours (GINI: 27.7), reintubation (GINI: 26.6), septic shock (GINI: 25.7), cardiac arrest (GINI: 16.1), and acute renal failure (GINI: 11.3). The mean day of occurrence for each complication is shown in Fig. 1. Conclusion: Devastating postoperative trajectories are characterized by a shared signature of complications. Early recognition and prevention may help prevent these unexpected mortalities in low risk patients." @default.
- W2891692012 created "2018-09-27" @default.
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- W2891692012 date "2018-03-01" @default.
- W2891692012 modified "2023-09-26" @default.
- W2891692012 title "When observed does not go as expected: devastating trajectories in hepatobiliary surgery" @default.
- W2891692012 doi "https://doi.org/10.1016/j.hpb.2018.02.311" @default.
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