447 Background: Transfusion is one of the causes of morbidity in hepatectomy, and is a predictor of mortality and cancer recurrence. This study sought to analyze the role of surgical approach in the incidence of transfusion in a large national dataset. Methods: The National Surgical Quality Improvement Program database identified patients undergoing hepatectomy between January 1, 2014 and December 31, 2014. Demographic information, surgical approach, perioperative characteristics, and short-term postoperative outcomes were compared for patients with and without perioperative red blood cell transfusion. Transfusions occurring from surgical start time to 72 hours postoperatively were included in the dataset. Results: A total of 3,064 patients were included in this study. Patients with right lobectomy and trisegmentectomy were more likely to receive transfusion compared to left and partial lobectomies (p < 0.001). Rate of transfusion was highest in unplanned minimally invasive conversion to open hepatectomy compared to open hepatectomy and minimally invasive surgery (25.2% vs. 21.2% vs. 6.7% respectively, p < 0.001). Patients requiring transfusion were more likely to suffer from other morbidity (47.1% vs. 19.6%, p < 0.001), had a longer median length of stay (7 vs. 5 days, p < 0.001), higher readmission rates (14.2% vs. 9.4%, p = 0.001), and higher 30-day mortality (4.9% vs. 0.8%, p < 0.001) compared to patients not receiving blood transfusions. Conclusions: Transfusion is the most common morbidity-defining complication associated with hepatectomy. Perioperative outcomes are significantly improved if no transfusion was needed. Further work should focus on avoiding unplanned conversion and minimizing blood loss.
68: The trend towards minimally invasive hysterectomy for benign indications: American College Of Surgeons-National Surgical Quality Improvement Program study from 2006-2011
