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Predictors of intraoperative blood loss in patients undergoing hepatectomy

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Abstract

Purpose

Despite recent advances in surgical techniques, blood loss can still determine the postoperative outcome of hepatectomy. Thus, the preoperative identification of risk factors predicting increased blood loss is important.

Methods

We studied retrospectively the clinical records of 482 patients who underwent elective hepatectomy for liver disease, and analyzed the clinicopathological and surgical parameters influencing intraoperative blood loss.

Results

Red cell transfusion was required for 165 patients (35 %). Based on blood transfusion requirement and hepatic failure, we estimated predictive cut-off values at 850 and 1500 ml. The factors found to be significantly associated with increased blood loss were as follows: male gender, obstructive jaundice, non-metastatic liver carcinoma, Child-Pugh B disease, decreased uptake ratio on liver scintigraphy, platelet count, or prothrombin activity, longer hepatic transection time, operating time, the surgeon’s technique, J-shape or median incision, major hepatectomy, and not using hemostatic devices (p < 0.05). Multivariate analysis identified male gender, low prothrombin activity, longer transection time, longer operation time, and not using hemostatic devices as factors independently associated with increased blood loss (p < 0.05).

Conclusions

Male gender and low prothrombin activity represent risk factors for increased blood loss during hepatectomy. Moreover, every effort should be made to reduce the transection and operating times using the latest hemostatic devices.

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Conflict of interest

Atsushi Nanashima and his co-authors have no conflict of interest.

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Authors and Affiliations

  1. Division of Surgical Oncology and Department of Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 8528501, Japan

    Atsushi Nanashima, Takafumi Abo, Keiko Hamasaki, Kouki Wakata, Masaki Kunizaki, Kazuo Tou, Hiroaki Takeshita, Shigekazu Hidaka, Terumitsu Sawai, Tomoshi Tsuchiya & Takeshi Nagayasu

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  1. Atsushi Nanashima
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  2. Takafumi Abo
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  3. Keiko Hamasaki
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  4. Kouki Wakata
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  5. Masaki Kunizaki
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  6. Kazuo Tou
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  7. Hiroaki Takeshita
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  9. Terumitsu Sawai
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  11. Takeshi Nagayasu
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Correspondence to Atsushi Nanashima.

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Nanashima, A., Abo, T., Hamasaki, K. et al. Predictors of intraoperative blood loss in patients undergoing hepatectomy. Surg Today 43, 485–493 (2013). https://doi.org/10.1007/s00595-012-0374-7

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  • DOI: https://doi.org/10.1007/s00595-012-0374-7

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