Predictors of Liver Failure in Non-Cirrhotic Patients Undergoing Hepatectomy

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

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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.

Original languageEnglish
Pages (from-to)3081-3089
Number of pages9
JournalWorld Journal of Surgery
Volume46
Issue number12
DOIs
StatePublished - Dec 2022

Bibliographical note

Publisher Copyright:
© 2022, The Author(s) under exclusive licence to Société Internationale de Chirurgie.

ASJC Scopus subject areas

  • Surgery

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