Outcomes of Liver Resection at Kenyatta National Hospital

Abstract

Background: Liver resections are lifesaving procedures for indicated conditions but are not commonly done in many African Countries, due to lack of skilled staff and attendant logistical support needed to execute them. Efforts have been gradually undertaken to advance care among patients with liver conditions. The postoperative outcomes of liver resections can vary depending on various factors, including the indication, the extent of the resection, the overall health of the patient, and the surgical techniques employed. In Kenya, structured documented anatomic liver resection was started formally in 2015 at Kenyatta National Hospital (KNH). Prior to this period, liver surgeries had been carried especially for emergencies, but there was no structured documentation. There has been a considerable effort to position KNH as a leading Centre for liver surgeries in the region by dedicating resources towards training personnel, investing in infrastructure and increasing uptake of liver resections with improved output. However, there is paucity of data on the postoperative outcomes of liver resections within the local context. This study aims to provide information on length of hospital stay,30day mortality, transfusion rate and bile leak rates following liver resection. Understanding these outcomes is crucial for improving patient management, enhancing recovery protocols, and ultimately reducing complications associated with liver resections. Our findings could inform local guidelines and practices, potentially leading to improved patient outcomes in our setting. Objective: To determine the postoperative outcomes of liver resections in Kenyatta National Hospital between January 2015 to March 2023. Methods: This was a retrospective study of prospectively maintained records. It was carried out at the Kenyatta National Hospital records department. Data was retrieved from the Medical Records of patients who underwent liver resections in Kenyatta National Hospital during the period of January 2015 to March 2023 after approval from KNH-UON ERC.This allowed the researcher to get adequate data to meet both the broad and specific objectives. The data obtained was recorded in a data extraction tool, put in an excel sheet then transferred for analysis in SPSS 23.0. The data was then summarized and presented as frequencies, proportions and percentages, in tables and graphs. Results: Total number of patients was 38. The mean age was 36.6 (SD± 25) 25 years with a range of between 8 days to 72 years. The mean age for the adult patients was 56 years. The common indications for surgery were benign conditions 52.6%(n=20) while 47.4%(n=18) had malignancies of which 28.9%(n =11) were primary liver tumour, 36.8%(n =14) and 18.4%(n=7) were metastases from another site. All of the patients underwent open surgery with 100% undergoing anatomical resection. There was zero 30-day mortality, 57.9% of the patients had ICU admission. Perioperative transfusion rate was 78.9% with a 95%Confidence Interval [CI]: 62.57% - 90.5%, Bile leak rate was 10.5% (n =4), 95%CI: 2.9% to 24.8%. The median length of hospital stay was 10 (Interquartile range [IQR]: 7 – 18.3) days. Conclusion and recommendation: There were no 30-day mortality among patients although majority of them required perioperative transfusion. The bile leak rate was lower than a previous study done in the same institution indicating an improvement in management with length of hospital stay of more than one week. To enhance patient care, we advocate for the refinement of perioperative protocols, particularly in minimizing perioperative blood transfusions. Further research into optimizing blood management strategies may lead to improved surgical outcomes and reduced healthcare burden