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. 2015 Dec;17(12):1058-65.
doi: 10.1111/hpb.12483. Epub 2015 Sep 19.

Early trends in serum phosphate and creatinine levels are associated with mortality following major hepatectomy

Garth S Herbert  1 , Kara B Prussing  2 , Amber L Simpson  1 , Michael I D'Angelica  1 , Peter J Allen  1 , Ronald P DeMatteo  1 , William R Jarnagin  1 , T Peter Kingham  1
Affiliations

Early trends in serum phosphate and creatinine levels are associated with mortality following major hepatectomy

Garth S Herbert et al. HPB (Oxford). 2015 Dec.

Abstract

Background: Mortality after major hepatectomy remains high and is frequently related to post-hepatectomy liver failure (PHLF). Other than pre-existing liver disease and a small future liver remnant, few patient factors or early postoperative indicators identify patients at elevated risk for PHLF and mortality.

Methods: Data on demographics, comorbidities, operative procedures and postoperative laboratory trends were reviewed for patients submitted to major hepatectomy (at least three Couinaud segments) for malignancy during 1998-2013. These factors were compared among patients who died within 90 days, survivors who met the 50-50 criteria and all remaining survivors.

Results: A total of 1528 patients underwent major hepatectomy during the study period. Of these, 947 had metastatic colorectal cancer and underwent resection of a median of four segments. Overall, 49 patients (3.2%) died within 90 days of surgery and 48 patients (3.1%) met the 50-50 criteria for PHLF; 30 of these patients survived 90 days. Operative blood loss was higher in patients who died within 90 days compared with survivors (1.0 l versus 0.5 l; P < 0.001). Despite equivalent perioperative resuscitation and urine output, non-survivors had higher creatinine and phosphate levels than survivors on postoperative day (PoD) 1 (1.1 mg/dl versus 0.9 mg/dl and 4.6 mg/dl versus 3.7 mg/dl, respectively; P < 0.001).

Conclusions: Early trends in creatinine and phosphate (between the day of surgery and PoD 1) identify patients at risk for PHLF and mortality.

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Figures

Figure 1
Figure 1
Perioperative laboratory trends, encompassing preoperative (within 2 weeks prior to surgery) data, day of surgery [postoperative day (PoD) 0] data, and data to 2 weeks following surgery, for (a) serum creatinine, (b) serum phosphate, (c) international normalized ratio (INR) and (d) total bilirubin. Values for each day were compared between the groups using the Mann–Whitney U-test. *P ≤ 0.002 for each day the significance star refers to Figure 1(b) phosphate pod 1, 2, and 3. (b) *P < 0.001 for PoD 1 and PoD 2, P = 0.007 for the day of surgery, P = 0.034 for PoD 3, and non-significant for all other days
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References

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