Prediction and early diagnosis of post hepatectomy complications

Abstract

Introduction: The role of perioperative clinical and laboratory characteristics in the prevention and early diagnosis of postoperative complications (POC) after hepatectomy has not been established despite their potential usefulness. The aim of this study was to assess some clinical and analytic variables for the prevention and early diagnosis of POC after hepatectomy. Methods: Perioperative demographic, clinical, tumor related and laboratory characteristics of 194 consecutive patients who underwent liver resection between January 2017 and July 2020 were analysed. Laboratory values included preoperative and early postoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and c-reactive protein (CRP). The relationship between perioperative clinical variable, NLR, LMR, CRP and POC was evaluated using univariable and multivariable logistic regression analyses. Receiver-operating characteristic (ROC) curve was used to measure the accuracy of postoperative CRP in diagnosing complications, and Youden index was used to find the most accurate cutoff value. Results: Elevated day-3 postoperative CRP (HR: 3.4; IQR: 1.9-6.4; p=0,01); elevated day-3 postoperative NLR (HR: 1.1, IQR 1-1.2, p=0,023) and day-3 abdominal pain (HR 3.6; IQR 1.8-7; p=0.001) were independent risk factors predicting POC. Area under the curve for postoperative day-3 CRP values as a predictor of POC was 0,658 (p<0,001) and 117mgr/L was the optimal cutoff with a sensitivity and specificity of 60% and 70% respectively. Conclusion: Elevated day-3 postoperative NLR, CRP and abdominal pain are useful for early diagnosis of complications in patients undergoing liver resection. Their use should be considered especially in the implementation of enhanced recovery program to minimize the risk of hospital readmission.