Invasive central venous monitoring during hepatic resection: unnecessary for most cases

Abstract

Background: Low central venous pressure (LCVP) improves outcome after hepatic resection and is the standard anesthetic management technique. Historically, this approach required a central venous catheter (CVC), but non-invasive assessment of CVP has evolved and is now routine. This study evaluates the impact of this change in practice and patient outcome after liver resection. Methods: A non-randomized, retrospective, cohort design was conducted using a prospectively maintained database of hepatic resections at our institution from 2007–2016. Infection, major morbidity, and 90-day mortality were compared between the group that received CVC and the group without CVC. Multivariable logistic regression was used for each outcome. CVC was forced into each model to assess association while controlling for other significant factors. Results: During the study period, 2518 hepatic resections were assessed and analyzed over three time periods (2007–2010, 2011–2013 and 2014–2016). CVCs were placed in 16.3% of the patients. The use of CVC was significant for 90-day mortality, 3.40% with CVC verses 1.0% without CVC (p 0.008). Presence of CVC was not significantly related to superficial wound infections (p 0.644), deep wound infections (p 0.389), or major complications (p 0.166) while controlling for other significant factors in the multivariable analysis. In patients submitted to a major resection (≥3 segments), CVC was not used in 75.8% of the cases. The results remained constant over the three time periods analyzed. Conclusion: The evolution to non-invasive assessment of fluid management for patients undergoing partial hepatectomy has not resulted in adverse outcomes.