Elevated Lactate is Independently Associated with Adverse Outcomes Following Hepatectomy

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Critical Care Medicine

Background:

• Arterial lactate monitoring is vital for assessing tissue hypoxia and guiding therapy.
• Early post-hepatectomy lactate (PHL) levels may indicate adverse outcomes.
• Identifying factors associated with PHL is essential for risk stratification.

Purpose of the Study:

• To determine the association between early post-hepatectomy lactate (PHL) and adverse outcomes.
• To identify clinical and operative factors associated with elevated PHL.
• To evaluate the predictive value of PHL for major morbidity, mortality, and length of stay.

Main Methods:

• Retrospective analysis of 749 hepatectomy patients from 2003-2012.
• Included 490 patients with available post-hepatectomy lactate measurements.
• Utilized univariable and multivariable analyses to assess factors associated with PHL and its relationship with outcomes.

Main Results:

• 71.4% of patients had elevated PHL (≥2 mmol/L).
• Factors associated with elevated PHL included cirrhosis, Charlson comorbidity index, major resections, longer procedure time, and greater blood loss.
• Increased PHL levels correlated with significantly higher rates of 30-day major morbidity and 90-day mortality.
• PHL was independently associated with 90-day mortality (OR 1.52) and 30-day morbidity (OR 1.19).

Conclusions:

• Elevated PHL in the early postoperative period signifies an increased risk of major morbidity and mortality.
• Close monitoring of patients with elevated PHL is recommended.
• Further research into lactate-guided fluid therapy post-hepatectomy is warranted.