Avoiding early postoperative complications in liver surgery. A multivariate analysis of 254 patients consecutively observed

Background. The number of hepatic resections for benign and malignant lesio ns has constantly increased over the past 20 years, as a consequence, surgi cal experience acquired over the past few years has decreased post-operativ e morbidity and mortality rates. Aims. Analysing the relation between potential preoperative risk factors an d the occurrence of severe post-operative complications, an attempt is made to identify the variables determining surgical risk in elective hepatic su rgery both in normal and cirrhotic liver. Patients and Methods. The hospital records of 254 patients who underwent el ective liver surgical procedures for hepatic lesions in our department, bet ween 1984 and 1999, were reviewed. The following variables were entered int o univariate and multivariate analysis: age, sex, nature of liver lesion (b enign or malignant), presence of cirrhosis or cholestasis, synchronous rese ction of other organs, disorders of blood coagulation, intraoperative blood requirement, the extent of surgical procedures and Pringle's manoeuvre. Results and Conclusions. The multivariate analysis of the 254 surgical oper ations on the liver indicates that the most powerful independent predictors favouring a serious adverse effect includes intra-operative blood transfus ions, advanced age and cirrhosis. Scrupulous preoperative clinical evaluati on and expert surgical skills minimize intra-operative bleeding and proved to be the most significant factors influencing morbidity and mortality rate s.