Risk factors for increased resource utilization and critical care complications in patients undergoing hepaticojejunostomy for biliary injuries.
This project aimed to study resource utilization and surgical outcomes after hepaticojejunostomy (HJ) for biliary injuries utilizing data from ACS NSQIP.



Data from the Participant Use Data File containing surgical patients submitted to the ACS NSQIP during the period of 1/1/2005-12/31/2014 were analyzed.



During the study period, 320 patients underwent HJ. Mean age was 50 years, and 109 (34%) were male. Forty-four percent of patients met criteria for ASA class III-V. Forty patients (12.5%) developed one or more critical care complications (CCC). Eighty-one patients (25%) experienced morbidity with a perioperative mortality rate of 1.9%. The mean age of these patients was 52 years, and 62% were male. Age and preoperative elevated alkaline phosphatase were independent predictors of CCC (p < 0.001 and 0.042, OR 1.035, OR 4.337, respectively). Patients ASA class III, age, and preoperative hypoalbuminemia were found to increase risk for prolonged LOS (OR 1.87, p = 0.041, OR 1.02, p = 0.049, OR 2.63, p = 0.001).



The most significant predictors of morbidity and increased resource utilization after HJ include increasing age, ASA class III or above, and preoperative hypoalbuminemia. Age and ASA class are the strongest predictors of CCC in these patients.
Transplant Center, University of Kentucky College of Medicine, Lexington, KY, USA.
Nicholas
N
Jackson
Transplant Center, University of Kentucky College of Medicine, Lexington, KY, USA.
Adam
A
Dugan
Transplant Center, University of Kentucky College of Medicine, Lexington, KY, USA.
Daniel
D
Davenport
Transplant Center, University of Kentucky College of Medicine, Lexington, KY, USA.
Michael
M
Daily
Transplant Center, University of Kentucky College of Medicine, Lexington, KY, USA.
Malay
M
Shah
Transplant Center, University of Kentucky College of Medicine, Lexington, KY, USA.
Jonathan
J
Berger
Transplant Center, University of Kentucky College of Medicine, Lexington, KY, USA. Electronic address: rgeda2@uky.edu.
Roberto
R
Gedaly
D000328:Adult; D000367:Age Factors; D000368:Aged; D001659:Biliary Tract / Q000293:injuries*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D003422:Critical Care / Q000191:economics*; D016208:Databases, Factual; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications / Q000191:economics / Q000628:therapy; D007049:Iatrogenic Disease / Q000191:economics; D007582:Jejunostomy / Q000009:adverse effects / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000191:economics; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D017064:Process Assessment, Health Care / Q000191:economics*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000601:surgery*