The significance of underlying cardiac comorbidity on morbidity and mortality after major hepatectomy: Analysis of the american college of surgeons national surgical quality improvement program

Abstract

Introduction: The risk of postoperative adverse events in patients with underlying cardiac disease undergoing major hepatectomy remains poorly characterized. Method: The NSQIP database was used to identify patients undergoing hemihepatectomy and trisectionectomy (CPT codes 47122, 47125, and 47130). Patient characteristics and postoperative outcomes were evaluated. Results: From 2005 to 2012, 5227 patients underwent major hepatectomy. Of those, 289 (5.5%) had history of major cardiac disease: 16 (5.6%) angina, 9 (3.1%) congestive heart failure, 3 (1%) myocardial infarction, 156 (54%) percutaneous coronary intervention, and 132 (46%) cardiac surgery. Thirty-day mortality was higher in patients with prior cardiac comorbidity (6.9% vs. 3.7%, p = 0.008). Specifically, the incidence of postoperative cardiac arrest requiring cardiopulmonary resuscitation (3.8% vs. 1.2%, p = 0.001) and myocardial infarction (1.7 vs. 0.4%, p = 0.011) were significantly higher in the cardiac group. Rates of intra-abdominal infection, sepsis, and venous thromboembolism were similar between the two groups. Multivariate analysis revealed that poor functional status, older age, and malnutrition, but not cardiac comorbidity, were significant predictors of 30-day mortality. Conclusions: Underlying cardiac comorbidity does not appear to be an independent predictor of mortality after major hepatectomy, however it is associated with a modest increase in postoperative adverse cardiac events. Careful patient selection remains necessary in patients with cardiac disease being considered for major hepatectomy as restrictive fluid management to achieve low central venous pressure during surgery may not be tolerated well by all patients.