Open AccessMorbidity of major hepatic resections: a 100‐case prospective study
Author(s) -
Pol Bernard,
Campan Pierre,
Hardwigsen Jean,
Botti Geneviève,
Pons Julien,
Le Treut Y. Patrice
Publication year - 1999
Publication title -
european journal of surgery
Language(s) - English
Resource type - Journals
eISSN - 1741-9271
pISSN - 1102-4151
DOI - 10.1080/110241599750006686
Subject(s) - medicine , perioperative , surgery , univariate analysis , pleural effusion , ascites , multivariate analysis , complication , hepatectomy , blood transfusion , prospective cohort study , retrospective cohort study , resection
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 μmol/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 ≥600 ml. The extent of resection did not correlate with postoperative complications. Multivariate analysis showed that volume of blood transfusion ≥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. Copyright © 1999 Taylor and Francis Ltd.