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Risk Factors of Hospital Mortality after Re-laparotomy for Post-hepatectomy Hemorrhage

World Journal of Surgery volume 37, pages 2394–2401 (2013)Cite this article

Abstract

Background

Post-hepatectomy hemorrhage (PHH) requiring re-laparotomy is a life-threatening situation and is associated with a considerably high hospital mortality rate. However, risk factors of hospital mortality in patients with this condition have not yet been investigated.

Methods

The perioperative data of 258 patients with hepatocellular carcinoma who underwent re-laparotomy for PHH from 1997 to 2011 were retrospectively reviewed and evaluated by univariate and multivariate analyses to identify risk factors of hospital mortality.

Result

Hospital death occurred in 43 patients between 16 h and 40 days after re-laparotomy, and the overall mortality rate was 16.7 %. The median time lag between first recognition of active bleeding and re-laparotomy was 6 h (range 0.5–34 h). The mortality of patients undergoing late re-laparotomy (≥6 h) was much higher than those undergoing early re-laparotomy (<6 h) (25 vs 8.6 %; P = 0.001). Multivariate analysis showed early time period (1997–2004) (P = 0.040), liver cirrhosis (P = 0.025), ineffective hemostasis during re-laparotomy due to coagulopathy (P = 0.038), late re-laparotomy (≥6 h) (P = 0.032), postoperative liver failure (P = 0.001), and postoperative acute renal failure requiring hemodialysis (P = 0.024) were independent risk factors of hospital mortality.

Conclusion

Immediate re-laparotomy is a key factor to reduce hospital mortality for patients with active bleeding after partial hepatectomy. More care should be taken in those patients who develop acute liver failure and/or serious acute renal failure after re-laparotomy.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (No. 81000166 and 81172020); Shanghai Program for Excellent Talents in Health System (No. XYQ2011033); Shanghai “Rising-Star” Science Foundation for Youths (No. 12QA1404800); and State Key Project on Infectious Diseases of China (2012ZX10002-016).

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Affiliations

  1. Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai, 200438, People’s Republic of China

    Tian Yang, Wan Yee Lau, Han Zhang, Xing Huang, Feng Shen, Jie-Wei Li & Meng-Chao Wu

  2. Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai, 200438, People’s Republic of China

    Li Li, Qian Zhong & Wei-Feng Yu

  3. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China

    Wan Yee Lau

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  1. Tian Yang
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  2. Li Li
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  3. Qian Zhong
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  4. Wan Yee Lau
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  5. Han Zhang
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  6. Xing Huang
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  7. Wei-Feng Yu
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  8. Feng Shen
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  9. Jie-Wei Li
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  10. Meng-Chao Wu
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Corresponding authors

Correspondence to Feng Shen or Jie-Wei Li.

Additional information

Tian Yang and Li Li contributed equally to this study.

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Yang, T., Li, L., Zhong, Q. et al. Risk Factors of Hospital Mortality after Re-laparotomy for Post-hepatectomy Hemorrhage. World J Surg 37, 2394–2401 (2013). https://doi.org/10.1007/s00268-013-2147-x

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  • DOI: https://doi.org/10.1007/s00268-013-2147-x

Keywords

  • Hospital Mortality
  • Partial Hepatectomy
  • Acute Liver Failure
  • Multiple Organ Dysfunction Syndrome
  • Pringle Maneuver