Choice of surgical technique influences perioperative outcomes in liver transplantation

Objective To examine how the choice of surgical technique influenced periop erative outcomes in liver transplantation. Summary Background Data The standard technique of orthotopic liver transpla ntation with venovenous bypass (WB) is commonly used to facilitate hemodyna mic stability. However, this traditional procedure is associated with uniqu e complications that can be avoided by using the technique of liver resecti on without caval excision (the piggyback technique). Methods A prospective comparison of the two procedures was conducted in 90 patients (34 piggyback and 56 with WE) during a 2.5-year period. Although b oth groups had similar donor and recipient demographic characteristics, pos ttransplant outcomes were significantly better for the patients undergoing the piggyback technique. The effect of surgical technique was examined usin g a stepwise approach that considered its impact on two levels of periopera tive and postoperative events. Results The analysis of the first level of perioperative events round that the piggyback procedure resulted in a 50% decrease in the duration of the a nhepatic phase. The analysis of the second level of perioperative events fo und a significant relation between the anhepatic phase and the duration of surgery and between the anhepatic phase and the need for blood replacement. The analysis of the first level of postoperative events found that the int ensive care unit stay was significantly related to both the duration of sur gery and the need for blood replacement. The intensive care unit stay was i n turn related to the second level of postoperative events, namely the leng th of hospital stay. Finally, total charges were directly related to length of hospital stay. The overall I-year actuarial patient and graft survival rates were 94% in the piggyback and 96% in the WE groups, respectively. Conclusions These data demonstrate that surgical choices in complex procedu res such as orthotopic liver transplantation trigger a chain of events that can significantly affect resource utilization. In the current healthcare c limate, examination of the sequence of events that follow a specific treatm ent may provide a more complete framework for choosing between treatment al ternatives.