Preoperative identification of intraoperative blood loss of more than 1,500 mL during elective hepatectomy

Abstract

Background: Despite recent advances in surgical techniques, hepatectomies remain one of the most hemorrhagic procedures in abdominal surgery. It is important to identify preoperatively patients who are at high risk of suffering massive intraoperative blood loss.

Methods: The clinical records of 251 patients who underwent an elective hepatectomy for liver tumors between September 2007 and December 2009 were reviewed retrospectively. A multivariate logistic regression analysis of preoperative factors potentially influencing intraoperative blood loss was performed. We set the cut-off value of the amount of blood loss for safe hepatectomy as less than 1,500 mL because no patients with blood loss of less than 1,500 mL received blood transfusion in this study. A scoring system to predict blood loss of more than 1,500 mL was constructed and validated in a cohort of 59 subsequent patients.

Results: Intraoperative blood loss of more than 1,500 mL was recognized in 35 of 251 patients (13.9%). Prothrombin activity < 70%, nonperipheral location of the tumor, involvement of hepatic veins, body mass index ≥ 23.0, and major hepatectomy were independently associated with intraoperative blood loss of more than 1,500 mL. The score was calculated by assigning 1 point for each of the 5 risk factors. The area under the receiver operating characteristic curve (AUC) was 0.814 (95% CI 0.731-0.898). This scoring system was highly predictive in the subsequent validation group of 59 patients (AUC = 0.839, 95% CI 0.710-0.969).

Conclusion: This predictive scoring system is considered to be useful for identifying before hepatectomy those patients with a high risk of intraoperative blood loss of more than 1,500 mL.

Keywords: hepatectomy; intraoperative blood loss; nomogram; predictive score; receiver operating characteristic curve.