Morbidity of Major Hepatic Resections: a 100-Case Prospective Study

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Abstract
To assess the morbidity and its main risk factors after major hepatic resection. Retrospective study of prospectively collected data. University hospital, France. 100 consecutive patients who underwent major hepatic resections, 1989-95. Major hepatic resection, defined as resection involving 3 or more segments according to Couinaud's classification, in all cases. All complications that affected outcome or prolonged hospital stay. Risk factors identified by univariate and multivariate analysis. 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 variables were significantly related to the morbidity: age >55 years, American Society of Anesthesiologists (ASA) grade II or more, bilirubin >80 micromol/L, alkaline phosphatase activity more than double the reference range, malignant tumours, abnormal liver parenchyma, simultaneous surgical procedures, operative time >4 hours, and perioperative blood transfusion > or =600 ml. The extent of resection did not correlate with postoperative complications. Multivariate analysis showed that volume of blood transfusion > or =600 ml and simultaneous surgical procedures were the most important independent risk factors for complicated outcome. The morbidity associated with major hepatic resections remains high, and the main determinants of outcome are intraoperative surgeon-related factors.

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