Perioperative risk factors associated with prolonged postoperative hospital stay in patients with severe complications after highly advanced hepatobiliary-pancreatic surgery: A single-center retrospective study

Abstract Background Postoperative length of hospital stay (PLOS) is an important indicator of surgical quality, particularly because postoperative complications are closely related to PLOS. Prolonged PLOS (PPLOS) increases treatment costs and delays the transition from surgery to adjuvant chemotherapy. PPLOS may also have an unfavorable impact on long-term prognosis. However, the risk factors for PPLOS, particularly after highly advanced hepatobiliary-pancreatic surgery (HBPS), have not been adequately investigated. In this study, we aimed to identify the perioperative risk factors for PPLOS following highly advanced HBPS. Methods In this single-center retrospective study, we included 737 patients who underwent highly advanced HBPS at Gifu University Hospital, Japan, between 2010 and 2023. Of these, 190 patients with severe postoperative complications (Clavien–Dindo classification grades ≥Ⅲ) were evaluated for perioperative risk factors for PPLOS using uni- and multivariate analyses. Results The median PLOS of patients with severe postoperative complications was 40 days, and 97 patients had a PPLOS. Univariate analysis indicated that pancreatic surgery, open surgery, clinically relevant postoperative pancreatic fistulas (CR-POPF), postoperative respiratory failure (PORF), and C-reactive protein levels > 15 mg/dL on postoperative day 3 significantly correlated with PPLOS. Multivariate analysis showed that open surgery (odds ratio [OR], 14193908; 95% confidence interval [CI], 2.06–; p = 0.01), CR-POPF (OR, 2.49; 95% CI, 1.10–5.77; p = 0.03), and PORF (OR, 5.74; 95% CI, 1.29–40.48; p = 0.02) were independent risk factors for PPLOS. Conclusions After highly advanced HBPS, the PLOS was significantly prolonged with the presence and severity of postoperative complications, regardless of the type of surgery. In cases with severe postoperative complications, open surgery, CR-POPF, and PORF may be risk factors for PPLOS. This study underlines the need for proficient minimally invasive surgery and appropriate perioperative management to avoid severe POPF and PORF, leading to a shorter PLOS after highly advanced HBPS.