The following is a summary of “Individual components of post-hepatectomy care pathways have differential impacts on length of stay,” published in the JANUARY 2023 issue of Surgery by Martin, et al.

Within bundled care pathways, evaluating the value of individual variable contributions to the length of stay (LOS) following a hepatectomy might be challenging.

Poisson regression and marginal effects models using Kawaguchi-Gayet (KG) complexity, perioperative factors, and pathways (minimally-invasive = MIS; low-intermediate-risk = KGI/II; high-risk = KGIII; combination) were used for extended post-hepatectomy LOS (>25% median).

For MIS, KGI/II, KGIII, and combination routes, the median LOS was 2, 4, 5, and 5 days (N = 978). Age, intraoperative fluids, delayed food tolerance, and combination cases were all linked to longer LOS by Poisson regression (P< 0.01). The results of a marginal effects analysis showed that the following factors increased the likelihood that the LOS would be longer: each year of age 0.03x, 250 mL intraoperative fluids 0.06x, each operative hour 0.2x, an additional day before diet tolerance 0.4x, combination cases 0.7x. MIS was associated with a 1.2x increased probability of shorter LOS.

The advantages of post-hepatectomy care routes to shorten LOS may be maximized by optimizing intraoperative fluids, operational time, and postoperative food while favoring the MIS method where practical.