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

Abstract

BackgroundLow central venous pressure (LCVP) anesthesia reduces blood loss during hepatic resection and historically has required a central venous catheter (CVC) for intra-operative monitoring. The aim of this study was to assess the effect of an evolution of practice to CVP monitoring without CVC on the perioperative outcomes after liver resection. MethodsA retrospective study of partial hepatectomy patients from 2007 to 2016 who were over 18 years of age was performed. ResultsOf 3903 patients having partial hepatectomy, 2445 (62%) met inclusion criteria, and 404 (16%) had a CVC. Overall morbidity (33% non-CVC vs 38% CVC P = 0.076), major morbidity (16% vs 20% P = 0.067), and infective complications (superficial wound infection) 3% vs 4% P = 0.429; deep wound infection (5% vs 6% P = 0.720) did not differ between the two groups. In multivariate analysis, superficial wound infection, deep wound infection, and major complications were not associated with the presence of a CVC. All-cause mortality at 90 days was associated with CVC presence (OR 3.45, CI 1.74–6.85, P = 0.001) and age (OR 1.05, CI 1.02–1.08, P < 0.001). ConclusionSince the adoption of non-invasive CVP monitoring, there has been no increase in adverse peri-operative outcomes.