Avoiding early postoperative complications in liver surgery. A multivariate analysis of 254 patients consecutively observed

• Published in: Digestive and liver disease 2001-05, Vol.33 (4), p.341-346
• Main Authors: Alfieri, S., Carriero, C., Caprino, P., Di Giorgio, A., Sgadari, A., Crucitti, F., Doglietto, G.B.
• Format: Article
• Language: English
• Subjects: Age Factors; Blood Transfusion - utilization; Female; Hepatectomy; Humans; Liver Cirrhosis - epidemiology; Liver Diseases - surgery; Liver Neoplasms - surgery; liver surgery; Male; Middle Aged; Morbidity; Multivariate Analysis; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Risk Factors
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/S1590-8658(01)80089-X

Background. The number of hepatic resections for benign and malignant lesions has constantly increased over the past 20 years, as a consequence, surgical experience acquired over the past few years has decreased post-operative morbidity and mortality rates. Aims. Analysing the relation between potential preoperative risk factors and the occurrence of severe post-operative complications, an attempt is made to identify the variables determining surgical risk in elective hepatic surgery both in normal and cirrhotic liver. Patients and Methods. The hospital records of 254 patients who underwent elective liver surgical procedures for hepatic lesions in our department, between 1984 and 1999, were reviewed. The following variables were entered into univariate and multivariate analysis: age, sex, nature of liver lesion (benign or malignant), presence of cirrhosis or cholestasis, synchronous resection of other organs, disorders of blood coagulation, intraoperative blood requirement, the extent of surgical procedures and Pringle's manoeuvre. Results and Conclusions. The multivariate analysis of the 254 surgical operations on the liver indicates that the most powerful independent predictors favouring a serious adverse effect includes intro-operative blood transfusions, advanced age and cirrhosis. Scrupulous preoperative clinical evaluation and expert surgical skills minimize intro-operative bleeding and proved to be the most significant factors influencing morbidity and mortality rates.