SSAT - Rate of Organ Space Infection Is Reduced With the Use of an Air Leak Test During Major Hepatectomies

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Rate of Organ Space Infection Is Reduced With the Use of an Air Leak Test During Major Hepatectomies
Hop Tran Cao^*², Victor Phuoc¹, Guillaume Passot¹, Suguru Yamashita¹, Claudius Conrad¹, Thomas Aloia¹, Jean-Nicolas Vauthey¹
¹Surgical Oncology, MD Anderson, Houston, TX; ²Surgical Oncology, Baylor College of Medicine, Houston, TX

Background: “Organ space infections” (OSI) is an important metric of interest that is closely monitored and often used as a surrogate marker for quality of operative care. The purpose of this study was to assess the impact of a previously described air leak test (ALT) on the incidence of OSI at the time of major hepatic resections.
Methods: A single-institution hepatobiliary database was queried for patients who underwent a major hepatectomy without biliary-enteric anastomosis between January 2009 and June 2015. Patient demographic and clinicopathologic characteristics and intraoperative data - including application of the ALT - were analyzed for associations with post-operative outcomes, including OSI, hospital length of stay (LOS), morbidity and mortality rates, as well as rates of readmissions.
Results: 319 patients were identified who met inclusion criteria, of whom 210 had an ALT performed at the time of hepatectomy. ALT and non-ALT patients did not differ in most disease (primary vs. metastasis, tumor number and size, degree of underlying liver injury) and treatment (portal vein embolization, neoadjuvant chemotherapy, blood loss) characteristics. ALT patients were more likely to have undergone trisegmentectomy than non-ALT patients (53% vs. 34%, p=0.001). ALT patients experienced lower rates of OSI and 90-day morbidity than non-ALT patients (5.2% vs. 12.8%, p=0.017 and 24.8% vs. 40.7%, p=0.003, respectively). In turn, OSI was the strongest independent predictor of longer LOS (OR=5.65; 95% CI, 3.29-8.00) and higher rates of 30- (OR=40.7; 95% CI, 13.0-127.5) and 45-day readmissions (OR=36.7; 95% CI, 11.9-112.7).
Conclusions: The use of an intraoperative air leak test significantly reduces the rate of organ space infection following major hepatectomy, and may also contribute to a reduction in post-discharge readmission rates.

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