Association between intraoperative hyperoxia and liver function in patients undergoing hepatectomy: a multicenter...

Area of Science:

• Hepatobiliary Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Oxygen (O₂) is essential but can be detrimental (hyperoxia) to organs.
• Emerging evidence suggests hyperoxia may harm the liver.
• The impact of high intraoperative partial pressure of arterial oxygen (PaO₂) on liver injury post-hepatectomy requires clarification.

Purpose of the Study:

• To investigate if high intraoperative PaO₂ (≥ 300 mmHg) during hepatectomy is linked to postoperative liver injury.
• To assess the association between elevated intraoperative oxygenation and liver function markers.

Main Methods:

• Comparative analysis of 292 hepatectomy patients, stratified by intraoperative PaO₂ (≥ 300 mmHg vs. < 300 mmHg).
• Primary outcomes: liver function markers (ALT, AST, Tbil, albumin, INR, PT). Secondary outcomes: hospital length of stay (LOS), postoperative complications.
• Validation in a prospective cohort of 76 patients; subgroup analyses by Child-Pugh score, age, surgical approach, and duration.

Main Results:

• No significant differences in postoperative liver function markers (ALT, AST, Tbil, albumin, INR, PT) between high and low PaO₂ groups.
• Comparable hospital LOS and postoperative complication rates between groups.
• Findings consistent across subgroup analyses and validated in the prospective cohort.

Conclusions:

• Intraoperative high PaO₂ (≥ 300 mmHg) is not associated with adverse effects on postoperative liver injury following hepatectomy.
• Current oxygen management strategies during hepatectomy appear safe regarding liver function.