Extended hepatic resection: A 6-year retrospective study of risk factors for perioperative mortality

BACKGROUND: Extended hepatic resection (more than four liver segments) is a major operative procedure that is associated with significant risk. The pu rpose of this study was to assess the impact of perioperative variables on in-hospital mortality after extended hepatectomy. STUDY DESIGN: Consecutive patients who underwent extended hepatic resection were studied. The prognostic value of 29 perioperative variables was evalu ated using in-hospital mortality as the endpoint. For each variable, the od ds ratio (95% confidence interval) for in-hospital mortality was calculated . Those variables with a lower confidence limit > 1 were considered importa nt risk factors. The population was stratified into categories of patients having the same number of risk factors, and mortality was estimated for eac h group. These data were used to develop a risk assessment algorithm. RESULTS: There were 14 deaths (6%) in 226 patients. Three preoperative vari ables (cholangitis, creatinine > 1.3 mg/dL, and total bilirubin > 6 mg/dL) and two operative variables (blood loss > 3 L and vena caval resection) app ear to be important factors for in-hospital mortality The mortality associa ted with the presence of any two of the five factors was 100% (5 of 5), and the mortality associated with the absence of these factors was 3% (6 of 19 1). CONCLUSIONS: Perioperative evaluation of patients undergoing extended hepat ic resection should include the quantitation of mortality risk factors. The combination of any two factors among preoperative cholangitis, elevated se rum creatinine, elevated serum bilirubin, high operative blood loss, and ve na cava resection may carry a high mortality risk. These results require pr ospective validation. (J Am Coll Surg 2001;132:47-53. (C) 2001 by the Ameri can College of Surgeons).