Major hepatic resections in a new hospital. How an experienced surgical group can positively affect outcomes

Background: Outcomes of major hepatic resections, once considered to be very morbid procedures, have now tremendously improved and have an expected procedure-related mortality of less than 5% in high volume centers. The purpose of this study is to evaluate outcomes of major hepatectomies performed by an experienced group, in a new hospital without prior experience in major abdominal operations. Methods: Data collected from all major hepatectomies performed in our institution between January 2016 and July 2017 was retrospectively collected and analyzed. Data included patient demographics, type of resection and post-operative outcomes. Results: Between January 2016 and July 2017, 52 patients underwent a major liver resection defined as more than two segments resection. 52% were females. The vast majority of the resections were performed in an open fashion and the procedure most commonly performed (49%) was right or left hepatectomy. Major lobectomies were routinely admitted to the ICU post- operatively. Mean EBL was 530 cc. Average length of stay was 8 days and there was one 30-day mortality due to multisystem organ failure. Infectious complications (SSIs, PNA, UTI) occurred in less than 10% of patients. Six patients required a radiologic intervention post-operatively. No patients required re-exploration. Conclusion: This study shows that outcomes from major hepatectomy in a virgin hospital can be driven by interested and experienced surgeons. The data suggests that expertise in HPB surgery can be transported to a new center.