Fast-track protocols in laparoscopic liver surgery: Applicability and correlation with difficulty scoring systems

Table 1 Baseline data and complications in the groups of candidates and non-candidates for a fast-track protocol

	Whole series (160 cases)	Excluded learning curve (first 40 cases)	Non-candidate for FTP (42 cases)	Candidate for FTP (78 cases)	P (FTP vs no FTP)
Baseline data
Age	59 ± 13	59 ± 14	58 ±15	59 ± 14	NS
Sex (M/F ratio)	83/77	66/54	29/13	37/41	0.023
BMI	27.56 ± 4.88	27.51 ± 5.03	27.69 ± 6.21	27.43 ± 4.44	NS
Malignancy, n (%)	122 (76.25)	93 (77.50)	32 (76.19)	61 (78.20)	NS
Postoperative stay	4.41 ± 4.68	4.50 ± 5.12	7.40 ± 7.17	2.94 ± 2.46	0.001
Operative time	253.81 ± 91.91	258.41 ± 89.81	294.19 ± 84.82	239.14 ± 86.95	0.001
Tradit minor/major	82/77	58/61	16/25	42/36	NS
Iwate					0.02
Low	26	19	5	14
Intermediate	60	43	9	34
Advanced	54	43	13	30
Expert	19	14	14	0
Iwate					0.009
I	68	48	13	35
II	24	18	3	15
III	67	53	25	28
Iwate					NS
Low	21	13	3	10
Moderate	81	58	18	40
High	52	43	15	28
Extremely high	4	4	4	0
Complications
CCI	8.10 ± 17.53	4.91 ± 12.51	16.57 ± 26.34	5.18 ± 11.52	0.01
No complications, n (%)	117 (73.1)	33 (82.5)	24 (57.1)	60 (76.9)	0.024
Redo surgery, n (%)	8 (5.0)	1 (2.5)	6 (14.3)	1 (1.3)	0.04
Readmission, n (%)	12 (7.5)	1 (2.5)	5 (11.9)	6 (7.7)	NS
Minor complications (I-II), n (%)	30 (18.8)	4 (10.0)	13 (31.0)	13 (16.7)	0.024
Major complications (IIIa, IIIb, IV)	13 (8.1)	3 (7.5)	5 (11.9)	5 (6.4)	NS
	6 IIIa	1 IIIa		4 IIIa
	2 IIIb	1 IIIb		1 IIIb
	2 Iva		2 Iva
	1 IVb		1 IVb
	2 V		2 V

BMI: Body mass index; CCI: Comprehensive complication index; F: Female; FTP: Fast-track protocols; M: Male; NS: Not significant.

Table 2 Multivariate models

Model
Iwate
Discharge 24 h		Sig	OR	Discharge 72 h	Sig	OR
Iwate		0.001	1.626 (1.2-2.18)	Iwate	0.01	1.46 (1.09-1.95)
				BMI 25-30	0.033	6.39 (1.16-35.30)
				BMI 30-35	0.013	8.51 (1.57-46.14)
Complications		Sig	OR	Readmissions	Sig	OR
Iwate		0.02	1.2 (1.03-1.41)	Iwate	0.007	1.58 (1.13-2.22)
BMI > 35		0.008	8.75 (1.76-43.44)
Southampton
Southampton	0.015		1.43 (1.07-1.92)
				BMI 25-30	0.032	6.08 (1.16-31.87)
				BMI 30-35	0.006	9.85 (1.91-50.70)
Complications	Sig		OR	Readmissions	Sig	OR
				Southampton	0.036	1.3 (1.01-1.68)
BMI > 35	0.013		7.09 (1.52-33.04)
Gayet
Discharge 24 h	Sig		OR	Discharge 72 h	Sig	OR
Gayet	0.004		1.85 (1.21-2.81)	Gayet	0.043	1.53 (1.01-2.31)
				BMI 25-30	0.042	5.72 (1.06-30.86)
				BMI 30-35	0.014	8.08 (1.52-42.99)
Complications	Sig		OR	Readmissions	Sig	OR
Gayet	0.008		1.48 (1.11-1.98)	Gayet	0.027	2.08 (1.08-4.01)
BMI > 35	0.009		8.56 (1.71-42.85)

Considering the end-point of discharge in < 24 h and < 72 h, complication rate and readmissions, complexity scores were included and analyzed independently. Age, body mass index, sex, American Society of Anesthesiologists score, previous surgery, malignancy, bilobar spread and liver disease were added as variables. BMI was an independent risk factor added to complexity scores in most of the models analyzed. BMI: Body mass index; OR: Odds ratio; Sig: Significance.