title: Simultaneous diaphragm and liver resection: a propensity-matched analysis of postoperative morbidity.
abstract: BACKGROUND
  Although a concomitant diaphragm resection might be required at the time of hepatectomy to achieve tumor-free surgical margins, studies addressing its effect on postoperative morbidity and mortality have been inconclusive. The objective of this study was to determine whether the need for diaphragm resection at the time of hepatectomy truly increases 30-day morbidity or mortality using data from the American College of Surgeons National Surgical Quality Improvement Program.
  
  
  METHODS
  Data were obtained from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program Participant User Files based on CPT coding. All patients undergoing a simultaneous liver and diaphragm resection were propensity-matched to a subset of liver resection patients not undergoing a diaphragm resection. The main outcomes measures were 30-day mortality and morbidity.
  
  
  RESULTS
  One hundred and ninety-two patients who underwent combined liver and diaphragm resection were matched to 192 patients treated with liver resection alone. The need for concomitant diaphragm resection was associated with a higher overall complication rate (38.54% vs 28.65%; p = 0.048), major complication rate (33.33% vs 23.44%; p = 0.030), and respiratory complication rate (14.06% vs 7.81%; p = 0.058). Postoperative mortality was similar between groups. Combined diaphragm and liver resection was also associated with longer operative times (median 311 minutes vs 247.5 minutes; p < 0.001), higher rates of intraoperative packed RBC transfusion (33.33% vs 23.44%; p = 0.037), and a longer length of hospitalization (median 7 vs 6 days; p = 0.002).
  
  
  CONCLUSIONS
  The results of this study, when taken into account with those reported previously, suggest that the need for diaphragm resection at time of hepatectomy increases postoperative morbidity but not mortality.
authors.affiliation: School of Medicine, Duke University Medical Center, Durham, NC 27710, USA. george.li@dm.duke.edu
authors.forename: George Z
authors.initials: GZ
authors.lastname: Li
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sloane
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lidsky
authors.forename: Georgia M
authors.initials: GM
authors.lastname: Beasley
authors.forename: Srinevas K
authors.initials: SK
authors.lastname: Reddy
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
mesh_terms: D000368:Aged; D003964:Diaphragm / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D058996:Quality Improvement; D012120:Respiration Disorders / Q000453:epidemiology; D013526:Surgical Mesh