Peri-operative risk factors for post operative liver failure after hepatectomy: an ACS-NSQIP analysis

Abstract

Background: Post-operative liver failure after hepatic resection is a serious and life threatening complication. The goal of the analysis is to identify independent contributors (predictors) for postoperative liver failure after hepatectomy to help guide informed decision making and counseling. Methods: Prospective 2014 ACS-NSQIP hepatectomy specific data was retrospectively reviewed for outcomes after hepatic surgery. All patients undergoing hepatic resection were captured in the database. An initial univariate analysis was performed based on all clinically relevant variables in the dataset. This was followed by multivariate logistic regression of all relevant variables using stepwise regression with a p value of 0.05. Results: 6,918 patients underwent hepatic resection during the study period. 88 variables were compared in a univariate fashion with the outcome of post-operative liver failure based on presumed clinical significance. 54 variables were significant on univariate analysis. These parameters were subjected to multivariate analysis. After multivariate analysis the following factors included in table 1 were deemed significant. (Please see included table). Conclusion: Based on this analysis, the pre-operative presence of ascites, HCC or cholangiocarcinoma, the need for percutaneous stenting, the need for right hepatectomy or trisectionectomy, the presence of gallbladder cancer, tumor size and amount of pre-operative ablations can all be used as predictors for post operative liver failure to assist in operative planning and patient counseling.Tabled 1VariableOdds ratio (CI)P valueT3 vs.T13.67 (1.38–9.73)=0.0089Percutaneous biliary stent5.99 (1.35–26.58)=0.0186Hepatocellular carcinoma705.17 (7.07–70331.2)=0.0052Gallbladder cancer371.85 (3.23–42836.6)=0.0145Intrahepatic cholangiocarcinoma141.33 (1.60–12481.33)=0.0303Trisectionectomy2.84 (0.93–8.68)=0.0669Preop hematocrit0.95 (0.91–0.99)=0.0363Preop platelets=0.0027Post op peak INR0.80 (0.66–0.97)=0.0223Post op peak bilirubin0.97 (0.96–0.98)<0.0001Pringle2.22 (1.40–3.52)=0.0007Bile leak req. perc. drainage6.05 (1.96–18.69)=0.0018T2 vs. T12.42 (1.09–5.37)=0.0292Male sex2.04 (1.23–3.40)=0.0061Total right lobectomy4.57 (1.65–12.64)=0.0034Ascites27.80 (4.14–186.77)=0.0006Locoregional ablation348.24 (1.65–73650.62)=0.0322Return to OR3.25 (1.31–8.07)=0.0109Laparoscopic liver resection0.15 (0.03–0.84)=0.0306NeoAdj/Hep. Infusion/portal embolization0.003 (.000023–0.45)=0.0226 Open table in a new tab