Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;46(12):3081-3089.
doi: 10.1007/s00268-022-06742-3. Epub 2022 Oct 8.

Predictors of Liver Failure in Non-Cirrhotic Patients Undergoing Hepatectomy

Gabriel Orozco  1 , Meera Gupta  1 , Diego Villagomez  1 , Malay Shah  1 , Francesc Marti  1 , Xiaonan Mei  1 , Alexandre Ancheta  1 , Siddharth Desai  1 , Fady Salama  1 , Karim Benrajab  1 , Daniel Davenport  1 , Roberto Gedaly  2
Affiliations

Predictors of Liver Failure in Non-Cirrhotic Patients Undergoing Hepatectomy

Gabriel Orozco et al. World J Surg. 2022 Dec.

Abstract

Background: Post-hepatectomy liver failure (PHLF) is associated with high mortality following liver resection. There have been limited studies evaluating predictors of PHLF and clinically significant PHLF in non-cirrhotic patients.

Methods: This was a retrospective cohort study using the National Surgical Quality Improvement Program database (NSQIP) to evaluate 8,093 non-cirrhotic patients undergoing hepatectomy from 2014 to 2018. Primary endpoints were PHLF and clinically significant PHLF (PHLF grade B or C).

Results: Among all patients, 4.74% (n = 383) developed PHLF and 2.5% clinically significant PHLF (n = 203). The overall 30-day mortality was 1.35% (n = 109), 11.5% (n = 44) in patients with PHLF, and 19.2% in those with clinically significant PHLF. Factors associated with PHLF were: metastatic liver disease (OR = 1.84, CI = 1.14-2.98), trisectionectomy (OR = 3.71, CI = 2.59-5.32), right total lobectomy (OR = 4.17, CI = 3.06-5.68), transfusions (OR = 1.99, CI = 1.52-2.62), organ/space SSI (OR = 2.84, CI = 2.02-3.98), post-operative pneumonia (OR = 2.43, CI = 1.57-3.76), sepsis (OR = 2.27, CI = 1.47-3.51), and septic shock (OR = 5.67, CI = 3.43-9.36). Patients who developed PHLF or clinically significant PHLF had 2-threefold increased risk of perioperative mortality. Post-hepatectomy renal failure (OR = 8.47, CI = 3.96-18.1), older age (OR = 1.04, CI = 1.014-1.063), male sex (OR = 1.83, CI = 1.07-3.14), sepsis (OR = 2.96, CI = 1.22-7.2), and septic shock (OR = 3.92, CI = 1.61-9.58) were independently associated with 30-mortality in patients with clinically significant PHLF.

Conclusion: PHLF in non-cirrhotic patients increased the risk of perioperative mortality and is associated with the extent of hepatectomy and infectious complications. Careful evaluation of the liver remnant, antibiotic prophylaxis, nutritional assessment, and timely management of post-operative infections could decrease major morbidity and mortality following hepatectomy.

PubMed Disclaimer

References

    1. Dokmak S, Fteriche FS, Borscheid R et al (2013) 2012 Liver resections in the 21st century: we are far from zero mortality. HPB (Oxford) 15:908–915
    1. Farges O, Goutte N, Bendersky N et al (2012) Incidence and risks of liver resection: an all-inclusive French nationwide study. Ann Surg 256:697–704 - PubMed
    1. Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International study group of liver surgery (ISGLS). Surgery 149:713–724 - PubMed
    1. Poon RT, Fan ST, Lo CM et al (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708 - PubMed - PMC
    1. Kingham TP, Correa-Gallego C, D’Angelica MI et al (2015) Hepatic parenchymal preservation surgery: decreasing morbidity and mortality rates in 4,152 resections for malignancy. J Am Coll Surg 220:471–479 - PubMed

MeSH terms

LinkOut - more resources