ISCHEMIC LIVER DYSFUNCTION AFTER ELECTIVE REPAIR OF INFRARENAL AORTIC-ANEURYSM - INCIDENCE AND OUTCOME

Objective: To assess the frequency of early postoperative liver dysfun ction in patients undergoing elective infrarenal aortic aneurysm repai r, their hospital course, and outcome. Design: A retrospective case-co ntrol study. Setting: A single tertiary referral center. Participants: A review of medical records of 942 consecutive asymptomatic patients with normal preoperative liver function test results who had elective infrarenal aortic aneurysm repair with infrarenal aortic cross-clampin g. The authors selected all patients who had an acute increase in seru m hepatic enzyme levels (minimum fivefold increase in aspartate aminot ransferase [AST] and twofold increase in lactate dehydrogenase [LDH] l evels) within the first 7 perioperative days (study patients). The con trol group consisted of 42 patients with normal postoperative liver fu nction test results, matched by age, sex, and year of surgery to study patients. Interventions: None. Measurements and Main Results: Aortic cross-clamping times, lowest intraoperative blood pressure, duration o f hypotension (systolic blood pressure less than or equal to 95 mmHg), lowest intraoperative base deficit, and estimated blood loss were com pared between control and study patients. The study also analyzed peri operative metabolic, hemostatic. hepatic, and renal function variables ; the intraoperative course: postoperative complications; and in hospi tal outcome. Fourteen of 942 patients (1.5%) comprised a study group. In 11 patients (1.2%), AST and LDH levels moderately increased, and th ree patients (0.3%) developed changes consistent with a diagnosis of a cute ischemic hepatitis (AIH). In all patients, the serum liver enzyme levels peaked between 24 and 72 postoperative hours. Three patients w ith AIH developed concomitant acute renal failure; one had associated disseminated intravascular coagulation (DIC) and died. Of 11 patients with moderate increases, one subsequently developed multisystem organ failure and died. The overall in-hospital mortality rate for patients with postoperative liver dysfunction was 14% (2/14) and for the contro l group it was 2.3% (1/42). The duration of hypotension and metabolic acidosis were more pronounced in patients who postoperatively develope d liver dysfunction (both p < 0.001); however, study and control patie nts did not differ in the duration of aortic cross-clamping, lowest in traoperative blood pressure, or estimated blood loss. Conclusion: Live r enzyme levels acutely increased in 1.5% of patients after elective i nfrarenal aortic aneurysm repair with infrarenal cross-clamping. In pa tients with moderately elevated serum liver enzyme levels, postoperati ve recovery was relatively uncomplicated, whereas all three patients w ith AIH developed acute renal failure and had a more complicated posto perative course. Those with postoperative liver dysfunction had a long er duration of intraoperative hypotension and more pronounced metaboli c acidosis. Copyright (C) 1998 by W.B. Saunders Company.