Morbidity of major hepatic resections: a 100-case prospective study

Objective: To assess the morbidity and its main risk factors after major he patic resection. Design: Retrospective study of prospectively collected data. Setting: University hospital, France. Subjects: 100 consecutive patients who underwent major hepatic resections, 1989-95. Interventions: Major hepatic resection, defined as resection involving 3 or more segments according to Couinaud's classification, in all cases. Main outcome measures: All complications that affected outcome or prolonged hospital stay. Risk factors identified by univariate and multivariate anal ysis. Results: 45 patients developed at least 1 complication and 7 died. The most common complications were: pleural effusion (n = 21), hepatic failure (n = 12), and ascites (n = 9). Univariate analysis showed that the following va riables were significantly related to the morbidity: age >55 years, America n Society of Anesthesiologists (ASA) grade II or more, bilirubin >80 mu mol /L, alkaline phosphatase activity more than double the reference range, mal ignant tumours, abnormal liver parenchyma, simultaneous surgical procedures , operative time >4 hours, and perioperative blood transfusion greater than or equal to 600 ml. The extent of resection did not correlate with postope rative complications. Multivariate analysis showed that volume of blood tra nsfusion greater than or equal to 600 ml and simultaneous surgical procedur es were the most important independent risk factors for complicated outcome . Conclusions: The morbidity associated with major hepatic resections remains high, and the main determinants of outcome are intraoperative surgeon-rela ted factors.