Learning Curve of Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis

Overview

Journal Front Surg

Specialty General Surgery

Date 2021 Dec 17

PMID 34917647

Authors

Yiwen Qiu

Xianwei Yang

Tao Wang

Shu Shen

Yi Yang

Bin Huang

WenTao Wang

Affiliations

Soon will be listed here.

Abstract

This retrospective study aimed to evaluate the safety and learning curve of liver resection and autotransplantation (ELRA). A total of 102 consecutive end-stage HAE patients who underwent ELRA between 2014 and 2020 in West China Hospital were enrolled. The primary endpoint was major postoperative complications (comprehensive complication index, CCI > 26). The ELRA learning curve was evaluated using risk-adjusted cumulative sum (RA-CUSUM) methods. The learning phases were determined based on RA-CUSUM analysis and tested for their association with intra- and post-operative endpoints. The median surgery time was 738 (659-818) min, with a median blood loss of 2,250 (1,600-3,000) ml. The overall incidence of major morbidity was 38.24% (39/102). Risk-adjusted cumulative sum analysis demonstrated a learning curve of 53 ELRAs for major postoperative complications. The learning phase showed a significant association with the hemodynamic unstable time (HR -30.29, 95% CI -43.32, -17.25, < 0.0001), reimplantation time (HR -13.92, 95% CI -23.17, -4.67, = 0.004), total postoperative stay (HR -6.87, 95% CI -11.33, -2.41, = 0.0033), and postoperative major morbidity (HR 0.25, 95% CI 0.09, 0.68, = 0.007) when adjusted for age, disease course, liver function, and remote metastasis. liver resection and autotransplantation is feasible and safe with a learning curve of 53 cases for major postoperative complications.

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