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Half of Postoperative Deaths After Hepatectomy may be Preventable

A Root-cause Analysis of a Prospective Multicenter Cohort Study

Khaoudy, Iman, MD*; Farges, Olivier, MD, PhD; Boleslawski, Emmanuel, MD, PhD; Vibert, Eric, MD, PhD§; Soubrane, Olivier, MD, PhD†,¶; Adham, Mustapha, MD, PhD||; Mabrut, Jean Yves, MD, PhD**; Christophe, Laurent, MD, PhD††; Bachellier, Philippe, MD, PhD‡‡; Scatton, Olivier, MD, PhD¶,§§; Le Treut, Yves-Patrice, MD, PhD¶¶; Regimbeau, Jean Marc, MD, PhD*,||||

doi: 10.1097/SLA.0000000000002837
ESA PAPERS

Objective: To perform a retrospective root-cause analysis of the causes of postoperative mortality after hepatectomy.

Background: Mortality after liver resection has not decreased over the past decade.

Methods: The study population was a prospective cohort of hepatectomies performed at hepatic, pancreatic, and biliary (HPB) centers between October 2012 and December 2014. Of the 1906 included patients, 90 (5%) died within 90 days of surgery. Perioperative data were retrieved from the original medical records. The root-cause analysis was performed independently by a senior HBP-surgeon and a surgical HBP-fellow. The objectives were to record the cause of death and then assess whether (1) the attending surgeon had identified the cause of death and what was it?, (2) the intra- and postoperative management had been appropriate, (3) the patient had been managed according to international guidelines, and (4) death was preventable. A typical root cause of death was defined.

Results: The cause of death was identified by the index surgeon and by the root-cause analysis in 84% and 88% of cases, respectively. Intra- and postoperative management procedures were inadequate in 33% and 23% of the cases, respectively. Guidelines were not followed in 57% of cases. Overall, 47% of the deaths were preventable. The typical root cause of death was insufficient evaluation of the tumor stage or tumor progression in a patient with malignant disease resulting in a more invasive procedure than expected.

Conclusion: Measures to ensure compliance with guidelines and (in the event of unexpected operative findings) better within-team communication should be implemented systematically.

*Department of Digestive Surgery, Amiens, France

Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Université Paris Clichy, France

Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France

§Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France

Department of Digestive Hepatobiliopancreatic Surgery, Hôpital Saint Antoine, Paris, France

||Department of Digestive Surgery, Hôpital Edouard Herriot, HCL, UCBL1, Lyon, France

**Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Croix Rousse, Lyon, France

††Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Saint André, Bordeaux, France

‡‡Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France

§§Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hopital Pitié Salpetrière, Paris, France

¶¶Digestive Surgery, Hôpital de la Conception, Marseille, France

||||SSPC (Simplification des Soins des Patients Complexes) - Unit of Clinical Research, University of Picardie Jules Verne, Amiens, France.

Reprints: Jean Marc Regimbeau, MD, PhD, Service de Chirurgie Digestive, Hôpital Sud, CHU d’Amiens, Avenue René Laennec, F-80054 Amiens Cedex 01, France. E-mail: regimbeau.jean-marc@chu-amiens.fr.

This study was funded by a Programme Hospitalier de Recherche Clinique grant (PHRC National 2011, AOM 11060) awarded to OF by the French Ministry of Health and by the Association de Chirurgie Hepato-Biliaire et de Transplantation Hépatique (ACHBT).

The authors have no financial relationship to disclose.

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