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Morbidity of major hepatic resections: a 100-case prospective study
B Pol1, P Campan, J Hardwigsen
1Department of Surgery, Hôpital de la Conception, Marseille, France.
Insights
Major hepatic resections have high morbidity. Key risk factors for complications include large blood transfusions and simultaneous procedures, highlighting surgeon-related influences on patient outcomes.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Major hepatic resections are complex procedures with significant associated morbidity.
- Identifying risk factors is crucial for improving patient outcomes after liver surgery.
Purpose of the Study:
- To evaluate the morbidity following major hepatic resections.
- To identify the primary risk factors associated with postoperative complications.
Main Methods:
- Retrospective analysis of prospectively collected data from 100 patients undergoing major hepatic resection.
- Major hepatic resection defined as removal of 3 or more liver segments.
- Complications and risk factors analyzed using univariate and multivariate methods.
Main Results:
- 45% of patients experienced complications, with 7 deaths.
- Common complications included pleural effusion, hepatic failure, and ascites.
- Independent risk factors for poor outcomes were significant perioperative blood transfusion (>=600 ml) and concurrent surgical procedures.
Conclusions:
- Morbidity after major hepatic resection is substantial.
- Intraoperative, surgeon-related factors, such as blood transfusion volume and performing simultaneous procedures, are critical determinants of patient outcomes.
Objective:
To assess the morbidity and its main risk factors after major hepatic resection.
Design:
Retrospective study of prospectively collected data.
Setting:
University hospital, France.
Subjects:
100 consecutive patients who underwent major hepatic resections, 1989-95.
Interventions:
Major hepatic resection, defined as resection involving 3 or more segments according to Couinaud's classification, in all cases.
Main Outcome Measures:
All complications that affected outcome or prolonged hospital stay. Risk factors identified by univariate and multivariate analysis.
Results:
45 patients developed at least 1 complication and 7 died. The most common complications were: pleural effusion (n = 21), hepatic failure (n = 12), and ascites (n = 9). Univariate analysis showed that the following variables were significantly related to the morbidity: age >55 years, American Society of Anesthesiologists (ASA) grade II or more, bilirubin >80 micromol/L, alkaline phosphatase activity more than double the reference range, malignant tumours, abnormal liver parenchyma, simultaneous surgical procedures, operative time >4 hours, and perioperative blood transfusion > or =600 ml. The extent of resection did not correlate with postoperative complications. Multivariate analysis showed that volume of blood transfusion > or =600 ml and simultaneous surgical procedures were the most important independent risk factors for complicated outcome.
Conclusions:
The morbidity associated with major hepatic resections remains high, and the main determinants of outcome are intraoperative surgeon-related factors.