TOPLINE

A collaborative model between hepatologists and hepatobiliary surgeons for the management of patients undergoing elective liver-related procedures appeared feasible, with discharge within 72 hours reported for 83% of procedures. Complications were reported in 19% of records, with percutaneous transhepatic biliary drainage (PTBD) associated with slightly longer hospital stays and higher rates of events within 30 days of discharge.

METHODOLOGY

• Co-management of patients undergoing invasive procedures by surgeons and internal medicine physicians has been associated with improved outcomes such as a reduced length of stay, lower mortality, and an increased likelihood of home discharge and patient satisfaction.
• Researchers implemented a joint management system in February 2023 at Padova University Hospital in Padova, Italy, for patients undergoing elective hepatobiliary procedures managed in a medical ward.
• A total of 462 procedures were performed and included 125 endoscopic retrograde cholangiopancreatographies (ERCP), 178 locoregional treatments (LRT) for liver lesions, 89 PTBD procedures, and 70 other procedures. Patients had complex underlying conditions, with 152 records of cirrhosis and 105 records documenting a history of a liver transplant.
• Admissions were jointly scheduled by a designated hepatologist and hepatobiliary surgeon and managed by a specialist nurse, with procedures typically performed on the day of admission and discharge expected within 72 hours.
• The outcome measures were discharge within 72 hours, complications and their management, and medical events within 30 days of discharge (unplanned reinterventions, emergency department visits, readmissions, and survival).

TAKEAWAY

• The average inpatient stay was 2.4 days, with patients discharged within 72 hours in 83% of records; PTBD procedures were associated with slightly longer stays than ERCP (3.3 vs 1.9 days; P < .05). Death was reported for two patients.
• Complications were reported in 19% of records and resulted in prolonged hospitalization (mean, 6.7 vs 1.2 days for procedures with vs without complications; P < .001), particularly for PTBD.
• Events within 30 days of discharge were more common with PTBD procedures than with ERCP and LRT (22% vs 8% and 5%).
• On multivariate analysis, prolonged hospitalization beyond 72 hours was predicted based on a history of a liver transplant (odds ratio [OR], 2.56; P = .032) and a history of a hepatobiliary malignancy (OR, 2.70; P = .015). The type of procedure and complications were independent predictors of events within 30 days (OR, 6.74; P = .016 and OR, 5.42; P < .001, respectively).

IN PRACTICE

"[T]he new collaborative model seems to be promising in terms of feasibility and safety," the authors wrote. "[I]t is our impression that short hospitalisations in an internal medicine ward is feasible and safe, may reduce resource utilization, and also have organizational advantages," they added.

SOURCE

The study was led by C Mangini, Department of Medicine, University of Padova, Padova, Italy. It was published online on September 8 in Digestive and Liver Disease.

LIMITATIONS

Medical vs surgical referral may have been affected by surgical complexity. Cost-effectiveness could not be determined from the available study data.

DISCLOSURES

No specific funding was reported in the study. The authors reported having no relevant competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.