Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Association between perioperative factors and DAH30 in oncology patients undergoing hepatobiliary resection: a retrospective cohort study (#183)

David Chen 1 2 3
  1. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
  2. Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  3. School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

Introduction

Currently in Australia, all hepatobiliary malignancies have a relative post-diagnosis one-year survival below 50%. Consequently, one month represents a significant proportion of the relative survival. Days Alive and At Home within 30 Days post-surgery (DAH30) is a novel composite outcome metric which accurately maps the perioperative period, where a lower score represents less time at home. This study aims to analyse perioperative factors relative to DAH30 in hepatobiliary cancer patients.

Methods

This was a retrospective, population-based cohort study. A sample of 498 consecutive adult patients undergoing hepatobiliary oncology surgery at Royal Prince Alfred Hospital and Chris O’Brien Lifehouse between 2016 and 2022 were included. Predictors were identified from literature and expert opinion, including patient characteristics and surgical outcomes. Following calculation of DAH30 score, zero-augmented regression was utilised to identify significant (p<0.05) predictors of DAH30.

Results

The median (IQR) age was 61 (52 to 70), and 317 (63.7%) of patients were men; median DAH30 was 22 (13 to 24). Univariate analysis identified 19 predictors significantly associated with DAH30. Subsequently, multivariable modelling identified that surgical approach, number of ICU admissions, sepsis influenced all DAH30[0-30] scores. BMI,  Charlson Comorbidity Index, and ‘other’ complications influenced DAH30[0] scores of 0, while operation time, presence of any complication, especially wound, gastrointestinal, and cardiovascular complications, and Clavien-Dindo Classification influenced non-zero DAH30[1-30] scores. Wound complications had the largest negative impact on DAH30[1-30] (IRR=0.77, 95%CI[0.66, 0.89]), and number of ICU admissions had the largest impact on DAH30[0] (OR=7.96, 95%CI[1.90, 33.34]).

Conclusion

This study identified 12 perioperative predictors significantly associated with DAH30, which can be used to improve patient-centred care. Anthropometric factors can be optimised with prehabilitation; increased and early postoperative monitoring for complications can likely reduce complication development and severity. While some predictors are non-modifiable, they can still be considered when evaluating the utility of clinical guidelines or biomedical developments.