Morbidity and mortality associated with liver resections for primary malignancies in children

• Published in: Pediatric surgery international 2014-05, Vol.30 (5), p.493-497
• Main Authors: Zwintscher, Nathan P., Azarow, Kenneth S., Horton, John D.
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Anemia - epidemiology; Blood Transfusion - statistics & numerical data; Causality; Child; Child, Preschool; Comorbidity; Digestive System Diseases - epidemiology; Female; Hepatectomy - adverse effects; Hepatectomy - mortality; Humans; Length of Stay - statistics & numerical data; Liver - surgery; Liver Neoplasms - epidemiology; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Postoperative Complications - epidemiology; Respiratory Tract Diseases - epidemiology; Surgery; United States - epidemiology
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-014-3492-z

Purpose Liver resection (LR) is a high-risk procedure with limited data in the pediatric surgical literature regarding short-term outcomes. Our aim was to characterize the patient population and short-term outcomes for children undergoing LR for malignancy. Methods We studied 126 inpatient admissions for children ≤20 years of age undergoing LR in 2009 using the Kids′ Inpatient Database. Patients had a principal diagnosis of a primary hepatic malignancy and LR listed as one of the first five procedures. Transplantations were excluded. Complications were defined by ICD-9 codes. High-volume centers performed at least 5 LR. Results The mean age was 5.83 years. The morbidity and mortality rates were 30.7 and 3.7 %, respectively. The most common causes of morbidity were digestive system complications (7.4 %), anemia (7.3 %), and respiratory complications (3.8 %). 43.9 % received a blood product transfusion. The average length of stay was 10.04 days. When compared to low-volume centers, high-volume centers increased the likelihood of a complication fourfold ( P  = 0.011) but had 0 % mortality ( P  = 0.089). Conclusion LR remains a procedure fraught with multiple complications and a significant mortality rate. High-volume centers have a fourfold increase in likelihood of complications compared to low-volume centers and may be related to extent of hepatic resection.