THE CLINICAL IMPLICATIONS OF HYPOPHOSPHATEMIA FOLLOWING MAJOR HEPATICRESECTION OR CRYOSURGERY

Objectives: To determine the incidence and predisposing factors leadin g to postoperative hypophosphatemia after major hepatic surgery and th e consequences of this electrolyte abnormality. Design: A retrospectiv e study. Setting: A university tertiary care referral center. Patients and Methods: Thirty-five consecutive patients undergoing either major hepatic resections or cryosurgery from July 1994 through January 1997 were retrospectively reviewed for the occurrence of hypophosphatemia and postoperative complications. Main Outcome Measures: Prolonged vent ilatory support, intensive care unit and hospital stays, and the incid ence of postoperative complications. Results: The overall incidence of hypophosphatemia in our series was 21 (67%) of 35 with a mortality ra te of 1 (2.8%) in 35. Mean operative time, estimated blood loss, parti al vascular occlusion time, and transfusion requirements were similar between the hypophosphatemic and the nonhypophosphatemic groups. The p resence of postoperative complications was significantly greater in th e hypophosphatemic group (17 [80%] of 21) vs the nonhypophosphatemic g roup (4 [28%] of 14) (P<.05). The incidence of antacid use in the hypo phosphatemic group (14 [66%] of 21) was significantly higher than the use in the nonhypophosphatemic group (2 [14%] of 14) (P<.05). Conclusi ons: Hypophosphatemia commonly occurs in major hepatic procedures. The presence of moderate hypophosphatemia is associated with the use of a ntacid therapy but no other perioperative or operative variables. The occurrence of hypophosphatemia correlates with an increased incidence of postoperative complications. Awareness of this entity can direct ag gressive replacement of phosphates and avert the occurrence of severe hypophosphatemia and associated complications.