Impact of postoperative mean arterial pressure on the incidence of postoperative complications after hepatic resection for primary liver malignancy

  • Masataka AmisakiEmail author
  • Takuki Yagyu
  • Ei Uchinaka
  • Masaki Morimoto
  • Naruo Tokuyasu
  • Teruhisa Sakamoto
  • Soichiro Honjo
  • Hiroaki Saito
  • Yoshiyuki Fujiwara
Original Article



We conducted this study to evaluate the impact of the postoperative mean arterial pressure (MAP) on surgical complications after hepatic resection.


The subjects of this study were 199 patients who underwent hepatic resection for primary liver malignancy between 2004 and 2013. A clinically relevant postoperative complication was defined as a Clavien–Dindo grade ≥ III complication.


Based on an MAP cut-off value of 81.1 mmHg, the patients were grouped as follows: low MAP on both postoperative days (PODs) 1 and 2 (continuously low MAP), normal MAP on both PODs 1 and 2 (normal MAP), and others (transiently low MAP). The continuously low MAP group had the highest incidence of complications and the normal MAP group had the lowest incidence of complications compared with the expected incidence for this cohort (p < 0.01 and p = 0.01, respectively). Multivariate analysis revealed that both a continuously and transiently low MAP were independent predictors of postoperative complications (p = 0.03 and p < 0.01, respectively). Among the subtypes of complications, a low MAP had a significant relationship with ascites/pleural effusion and respiratory complications (p < 0.01 and p = 0.03, respectively).


A low MAP on POD 1 and/or 2 is an independent predictor of postoperative complications.


Liver Resection Postoperative complication Blood pressure 


Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare.


  1. 1.
    Japan LCSGo. Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg. 1990;211:277–87.Google Scholar
  2. 2.
    Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406 (discussion—7).CrossRefGoogle Scholar
  3. 3.
    Cohnert TU, Rau HG, Buttler E, Hernandez-Richter T, Sauter G, Reuter C, et al. Preoperative risk assessment of hepatic resection for malignant disease. World J Surg. 1997;21:396–400.CrossRefGoogle Scholar
  4. 4.
    Cescon M, Vetrone G, Grazi GL, Ramacciato G, Ercolani G, Ravaioli M, et al. Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg. 2009;249:995–1002.CrossRefGoogle Scholar
  5. 5.
    Welzel TM, Graubard BI, El-Serag HB, Shaib YH, Hsing AW, Davila JA, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case–control study. Clin Gastroenterol Hepatol. 2007;5:1221–8.CrossRefGoogle Scholar
  6. 6.
    Kobayashi M, Ikeda K, Saitoh S, Suzuki F, Tsubota A, Suzuki Y, et al. Incidence of primary cholangiocellular carcinoma of the liver in japanese patients with hepatitis C virus-related cirrhosis. Cancer. 2000;88:2471–7.CrossRefGoogle Scholar
  7. 7.
    Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The “50–50 criteria” on postoperative day 5. Ann Surg. 2005;242:824–9.CrossRefGoogle Scholar
  8. 8.
    Thooft A, Favory R, Salgado DR, Taccone FS, Donadello K, De Backer D, et al. Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care. 2011;15:R222.CrossRefGoogle Scholar
  9. 9.
    Gomez EV, Gonzalez AT, Bertot LC, Yasells Garcia A, Rodriguez YS, Perez YM. Arterial blood pressure is closely related to ascites development in compensated HCV-related cirrhosis. PloS One. 2014;9:e95736.CrossRefGoogle Scholar
  10. 10.
    Monk TG, Bronsert MR, Henderson WG, Mangione MP, Sum-Ping ST, Bentt DR, et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015;123:307–19.CrossRefGoogle Scholar
  11. 11.
    van Waes JA, van Klei WA, Wijeysundera DN, van Wolfswinkel L, Lindsay TF, Beattie WS. Association between intraoperative hypotension and myocardial injury after vascular surgery. Anesthesiology. 2016;124:35–44.CrossRefGoogle Scholar
  12. 12.
    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552.CrossRefGoogle Scholar
  13. 13.
    Tomimaru Y, Takada K, Shirakawa T, Noguchi K, Morita S, Imamura H, et al. Surgical Apgar score for predicting complications after hepatectomy for hepatocellular carcinoma. J Surg Res. 2018;222:108–14.CrossRefGoogle Scholar
  14. 14.
    Vaughan RB, Chin-Dusting JP. Current pharmacotherapy in the management of cirrhosis: focus on the hyperdynamic circulation. Expert Opin Pharmacother. 2003;4:625–37.CrossRefGoogle Scholar
  15. 15.
    Fernandez-Seara J, Prieto J, Quiroga J, Zozaya JM, Cobos MA, Rodriguez-Eire JL, et al. Systemic and regional hemodynamics in patients with liver cirrhosis and ascites with and without functional renal failure. Gastroenterology. 1989;97:1304–12.CrossRefGoogle Scholar
  16. 16.
    Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22:696–9.CrossRefGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg. 2004;240:205–13.CrossRefGoogle Scholar
  18. 18.
    Dunnett CW. New tables for multiple comparisons with a control. Biometrics. 1964;20:482–91.CrossRefGoogle Scholar
  19. 19.
    Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65–70.Google Scholar
  20. 20.
    Kusano T, Sasaki A, Kai S, Endo Y, Iwaki K, Shibata K, et al. Predictors and prognostic significance of operative complications in patients with hepatocellular carcinoma who underwent hepatic resection. Eur J Surg Oncol. 2009;35:1179–85.CrossRefGoogle Scholar
  21. 21.
    Yang T, Zhang J, Lu JH, Yang GS, Wu MC, Yu WF. Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg. 2011;35:2073–82.CrossRefGoogle Scholar
  22. 22.
    Walsh M, Devereaux PJ, Amit XG arg, Kurz A, Turan A, Rodseth RN, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery. Anesthesiology. 2013;119:507–15.CrossRefGoogle Scholar
  23. 23.
    LeDoux D, Astiz ME, Carpati CM. EC. R. Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med. 2000;28:2729–32.CrossRefGoogle Scholar
  24. 24.
    Thacker JK, Mountford WK, Ernst FR, Krukas MR, Mythen MM. Perioperative fluid utilization variability and association with outcomes: considerations for enhanced recovery efforts in sample US surgical populations. Ann Surg. 2016;263:502–10.CrossRefGoogle Scholar
  25. 25.
    Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol. 2006;20:265–83.CrossRefGoogle Scholar
  26. 26.
    Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med. 2018;378:2263–74.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Masataka Amisaki
    • 1
    Email author
  • Takuki Yagyu
    • 1
  • Ei Uchinaka
    • 1
  • Masaki Morimoto
    • 1
  • Naruo Tokuyasu
    • 1
  • Teruhisa Sakamoto
    • 1
  • Soichiro Honjo
    • 1
  • Hiroaki Saito
    • 1
  • Yoshiyuki Fujiwara
    • 1
  1. 1.Division of Surgical Oncology, Department of Surgery, School of MedicineTottori University Faculty of MedicineYonagoJapan

Personalised recommendations