Quantintative risk assessment for post-hepatectomy liver failure: analysis of the 2015 ACS-NSQIP procedure-targeted hepatectomy database

Abstract

Background: Post-hepatectomy liver failure (PHLF) is a feared complication following liver resection and a major cause of significant perioperative morbidity and mortality. The aim of this study was to analyze the quantitative risk association of perioperative factors with PHLF. Methods: Analysis of patients in the 2015 ACS NSQIP Procedure-Targeted Hepatectomy Database, who underwent hepatectomy, was done. In this database, PHLF is graded according to the International Study Group of Liver Surgery (ISGLS). Multiple regression model was performed to assess the association of perioperative factors with PHLF. Results: A total of 3,854 patients who underwent hepatectomy were analyzed. PHLF occurred in 218 patients (5.7%). Of these, 106 (48.6%) had ISGLS grade A PHLF, 64 (29.4%) grade B, and 48 (22%) grade C. Open hepatectomy was associated with 13-fold risk of PHLF compared to minimally invasive hepatectomy (p = 0.018), postoperative bile leak with a 5-fold risk of PHLF (p < 0.0001) and liver cirrhosis and parenchymal congestion with 2-fold risk of PHLF (p = 0.004 and 0.02). Increased INR and bilirubin on or after postoperative day 5 were associated with slightly increased risk of PHLF (p < 0.0001 and p < 0.001). Preoperative stenting, hepatitis B/C status, intraoperative ablation, major versus minor hepatectomy, duration of drain, and drain bilirubin level had no association with PHLF. Pringle maneuver use and hepatobiliary reconstruction were protective against PHLF. Conclusion: PHLF occurs in 5.7% of hepatectomies. The risk of developing PHLF is 13-fold after open hepatectomy compared to minimally invasive hepatectomy, 5-fold in patients with post- hepatectomy bile leak, and 2-fold in patients with liver parenchymal congestion and cirrhosis. Use of Pringle maneuver and hepatobiliary reconstruction are protective against PHLF.