Hepatic venous hemoglobin oxygen saturation predicts liver dysfunction after hepatectomy

Area of Science:

• Hepatobiliary Surgery
• Surgical Monitoring
• Liver Physiology

Background:

• Hepatectomy is a complex procedure with risks of postoperative liver dysfunction.
• Accurate intraoperative monitoring is crucial for predicting patient outcomes.
• Hepatic venous oxygen hemoglobin saturation (ShvO2) is a potential indicator of liver oxygenation.

Purpose of the Study:

• To investigate if intraoperative ShvO2 measurements can predict postoperative aminotransferase levels and patient outcomes in hepatectomy patients.
• To establish thresholds for ShvO2 duration that correlate with adverse postoperative events.

Main Methods:

• A fiberoptic catheter was used to continuously measure ShvO2 in the hepatic vein of 83 hepatectomy patients.
• The duration of intraoperative ShvO2 falling below specific percentages (10%, 20%, 30%, 40%, 50%) was calculated.
• Postoperative serum aminotransferase activities, liver failure incidence, and mortality were assessed in relation to ShvO2 durations.

Main Results:

• Increased postoperative aminotransferases were linked to durations of ShvO2 <= 10%, 20%, 30%, 40%, and 50% exceeding 1, 11, 31, 51, and 181 minutes, respectively.
• Postoperative liver failure incidence rose significantly when ShvO2 <= 20%, 30%, and 40% exceeded 11, 31, and 51 minutes.
• Mortality from liver failure was higher when ShvO2 <= 30% and 40% durations surpassed 31 and 51 minutes.

Conclusions:

• Intraoperative ShvO2 monitoring is a valuable tool for predicting postoperative aminotransferase elevations after hepatectomy.
• ShvO2 monitoring can effectively predict patient outcomes, including the risk of postoperative liver failure and associated mortality.
• Continuous ShvO2 measurement offers a promising method for enhancing perioperative management in hepatectomy patients.