Poster Presentation NSW State Cancer Conference 2023

Association between perioperative factors and DAH30 in oncology patients undergoing hepatobiliary resection. (#173)

David T.Y. Chen 1 2 3 , James Morkaya 1 , Doruk Seyfi 1 2 4 , Charbel Sandroussi 1 2 4 5 , David Yeo 1 4 5 , Sascha Karunaratne 1 2 5 , Daniel Steffens 1 2 5
  1. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
  2. Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  3. School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
  4. Department of Hepatobiliary and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  5. Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia

Introduction

In 2022, hepatic malignancies were the 12th most common cancer diagnosed in Australia. Unfortunately, at one-year post-diagnosis, no hepatobiliary malignancy had a relative survival above 50%. Consequently, one month represents a significant proportion of a patient’s expected relative survival. Days Alive and At Home within 30 Days of surgery (DAH30) is a novel outcome measure that accurately maps the postoperative journey using inpatient days spent at any healthcare facility, where a lower score represents less time at home. This study aims to comprehensively analyse perioperative factors and their correlation with DAH30 in hepatobiliary resection patients.

 

Methods

This was a retrospective, population-based cohort study. A sample of 498 consecutive patients aged 18 years or older, who underwent major hepatobiliary surgical oncology procedures at Royal Prince Alfred Hospital (RPAH) and Chris O’Brien Lifehouse (COBLH) over a six-year period were identified and included. Potential covariates and confounders were identified from existing literature and expert opinion, and included patient demographics, preoperative (e.g., anthropometrics, tumour data), intraoperative (e.g., surgical approach, operation time, histopathology), and postoperative (e.g., ICU data, complication data) characteristics. DAH30 scores were calculated, and multivariable regression analysis modelling was performed.

 

Results

The median (interquartile range [IQR]) age was 61 (52 to 70), and 317 (63.7%) of patients were men. Accounting for readmission, transfer to other facilities, and death, the median (IQR) DAH30 was 22.0 (13.0 to 24.3). Univariate analysis identified 17 demographic and perioperative characteristics (4 preoperative, 3 intraoperative, and 10 postoperative) as being significantly associated with DAH30 (p<0.05). Multivariate backwards linear regression analysis of these 17 variables identified 10 variables (BMI, aged-adjusted Charlson Comorbidity Index [aaCCI], ASA physical status, surgical approach, operation time, number of postoperative ICU admissions, Clavien-Dindo Classification, wound and gastrointestinal complications, and sepsis) that significantly impacted DAH30 (p<0.0005, R2=0.538). Intraoperative factors, sepsis, and wound complications were most significant in reducing DAH30 scores (p<0.0005); aaCCI significantly influenced DAH30 (p<0.05), however patient age did not (p=0.723).   

 

Discussion

This study identified ten perioperative factors significantly correlated with DAH30, which can be used to inform the improvement of patient-centred care by the treating multidisciplinary team. Preoperative anthropometric factors can be optimised with prehabilitation, while increased and early postoperative monitoring for complications can likely reduce complication severity. While some factors are non-modifiable, they can still be considered when evaluating the utility of biomedical developments e.g., with new equipment or surgical techniques.

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