INFECTION AFTER HEPATIC RESECTION IN THE ELDERLY

From 1986 to 1995, 97 patients older than 65 years of age underwent he patic resection at the Department of General Surgery, Hospital Lainz, Vienna. The population consisted of 39 men and 58 women with a mean ag e of 74 +/- 5.5 pears. Primary neoplasia was the cause of resection in 35 patients, gallbladder cancer in 16 patients, and metastatic diseas e to the liver in 30 patients. Six patients underwent hepatic resectio n because of benign disease. The overall rate of major resections (gre ater than or equal to 3 liver segments) was 73% and the overall mortal ity was 13.5%. Sixty-five postoperative complications were recorded in 42 patients, and infection was the leading problem in nearly all of t hese patients (95%). The histologic type of tumor rather than the magn itude of resection had an influence on clinical mortality and morbidit y, All complications occurred in patients with malignant disease (P = 0.03). Adverse effects on postoperative morbidity were observed in ade nocarcinoma of the hepatic ducts, gallbladder carcinoma, and cholangio cellular carcinoma (P = 0.003). Intraabdominal infections were found i n 25% of our patients and were due to biliary leakage in 58%, but had no significant impact on survival. Pneumonia was the leading complicat ion in association with patient survival. All patients who developed p neumonia as a late complication during a complicated course died posto peratively (P = 0.0001). All of these patients had a reduced grade of mobilization, Severe preoperative liver dysfunction carried a signific antly higher risk for postoperative morbidity and mortality (P = 0.003 and 0.01), which showed an incremental risk with age >80 (P = 0.002 a nd 0.0001). Right lobectomies and extended right lobectomies carried a significantly increased risk for postoperative morbidity (P = 0.003). Infection is associated with nearly every complication recorded after hepatic resection in the elderly. Pneumonia as a late complication po ses a worse prognosis in elderly patients who underwent hepatic resect ion. Patients older than 65 years of age and especially those older th an 80 years of age are more liable to succumb to complications that ar e predominantly infectious. Better local drainage procedures may reduc e intra-abdominal infectious complications and early mobilization of t he patients may improve the rate of systemic infectious complications and final outcome.