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.