Medical management of patients undergoing elective, liver-related invasive procedures - a novel collaboration model between hepatobiliary surgeons and hepatologists.

BACKGROUND AND AIMS: To describe and evaluate a joint surgical-hepatology management model for patients undergoing elective hepatobiliary procedures within a short medical hospitalization.

METHODS

Elective admissions were jointly scheduled by a designated hepatologist and hepatobiliary surgeon, managed by a specialist nurse and monitored between Feb 2023 (when the system was implemented) and Dec 2025. Outcomes of interest included discharge within 72 hours, complications and costs.

RESULTS

462 procedures were performed over the observation period, including 125 endoscopic retrograde cholangiopancreatographies (27%), 178 locoregional treatments for liver malignancies (39%), 89 percutaneous transhepatic biliary drainages (PTBD, 19%), and 70 (15%) "other". Most common underlying conditions were cirrhosis (33%), a history of liver transplantation (23%), and hepatobiliary malignancy (59%). Average inpatient stay was 2.4±6.1 days, with 85% discharged within 72 hours. Complications occurred in 88 patients (19%), prolonging hospitalisation (6.7±12.5 vs 1.2±0.6 days, p<0.001), with PTBD-related complications being associated with the longest inpatient stays and a higher likelihood of medical events within 30 days of discharge.

CONCLUSION

Hepatological-surgical co-management of patients undergoing elective hepatobiliary procedures in a medical ward appears feasible and safe, at least in a high-volume tertiary referral centre.