Abstract
BackgroundThe aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection.MethodsSerum lactate concentration was recorded at the end of liver resection in a consecutive series of 488 patients over a seven-year period. Liver function, coagulation and electrolyte tests were performed post-operatively. Renal dysfunction was defined as a creatinine rise of >1.5x the pre-operative value.ResultsThe median lactate was 2.8 mmol/L (0.6 to 16 mmol/L) and was elevated (≥2 mmol/L) in 72% of patients. The lactate concentration was associated with peak post-operative bilirubin, prothrombin time, renal dysfunction, length of hospital stay and 90-day mortality (P < 0.001). The 90-day mortality in patients with a post-operative lactate ≥6 mmol/L was 28% compared to 0.7% in those with lactate ≤2 mmol/L. Pre-operative diabetes, number of segments resected, the surgeon’s assessment of liver parenchyma, blood loss and transfusion were independently associated with lactate concentration.ConclusionsInitial post-operative lactate concentration is a useful predictor of outcome following hepatic resection. Patients with normal post-operative lactate are unlikely to suffer significant hepatic or renal dysfunction and may not require intensive monitoring or critical care.
Highlights
The aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection
Factors associated with peri-operative complications and death include patient age [7,8] and gender [9,10], hospital annual number of liver resections undertaken [9,11], pathologic origin of liver tumour [9,11], pre-operative liver and renal dysfunction [8,10], diabetes [12,13], chronic liver
The American Society of Anesthesiologists (ASA) grade and Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) scores are used in the risk prediction of many types of surgery [21,22] including liver surgery [23]
Summary
The aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection. The American Society of Anesthesiologists (ASA) grade and Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) scores are used in the risk prediction of many types of surgery [21,22] including liver surgery [23]. These scores may not be applicable to the unique stresses of liver resection. Failure of multiple organ systems may contribute to death following liver resection and there is a need for a global peri-operative measure to predict the risk of developing significant post-operative morbidity and death
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