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Predictors of Liver Failure in Non-Cirrhotic Patients Undergoing Hepatectomy

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Abstract

Background

Post-hepatectomy liver failure (PHLF) is associated with high mortality following liver resection. There have been limited studies evaluating predictors of PHLF and clinically significant PHLF in non-cirrhotic patients.

Methods

This was a retrospective cohort study using the National Surgical Quality Improvement Program database (NSQIP) to evaluate 8,093 non-cirrhotic patients undergoing hepatectomy from 2014 to 2018. Primary endpoints were PHLF and clinically significant PHLF (PHLF grade B or C).

Results

Among all patients, 4.74% (n = 383) developed PHLF and 2.5% clinically significant PHLF (n = 203). The overall 30-day mortality was 1.35% (n = 109), 11.5% (n = 44) in patients with PHLF, and 19.2% in those with clinically significant PHLF. Factors associated with PHLF were: metastatic liver disease (OR = 1.84, CI = 1.14–2.98), trisectionectomy (OR = 3.71, CI = 2.59–5.32), right total lobectomy (OR = 4.17, CI = 3.06–5.68), transfusions (OR = 1.99, CI = 1.52–2.62), organ/space SSI (OR = 2.84, CI = 2.02–3.98), post-operative pneumonia (OR = 2.43, CI = 1.57–3.76), sepsis (OR = 2.27, CI = 1.47–3.51), and septic shock (OR = 5.67, CI = 3.43–9.36). Patients who developed PHLF or clinically significant PHLF had 2–threefold increased risk of perioperative mortality. Post-hepatectomy renal failure (OR = 8.47, CI = 3.96–18.1), older age (OR = 1.04, CI = 1.014–1.063), male sex (OR = 1.83, CI = 1.07–3.14), sepsis (OR = 2.96, CI = 1.22–7.2), and septic shock (OR = 3.92, CI = 1.61–9.58) were independently associated with 30-mortality in patients with clinically significant PHLF.

Conclusion

PHLF in non-cirrhotic patients increased the risk of perioperative mortality and is associated with the extent of hepatectomy and infectious complications. Careful evaluation of the liver remnant, antibiotic prophylaxis, nutritional assessment, and timely management of post-operative infections could decrease major morbidity and mortality following hepatectomy.

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Authors and Affiliations

  1. Department of Surgery-Transplant Division, College of Medicine, University of Kentucky, 740 South Limestone, Suite K301, Lexington, KY, 40536-0284, USA

    Gabriel Orozco, Meera Gupta, Diego Villagomez, Malay Shah, Francesc Marti, Xiaonan Mei, Alexandre Ancheta, Siddharth Desai, Fady Salama, Karim Benrajab, Daniel Davenport & Roberto Gedaly

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  1. Gabriel Orozco
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  2. Meera Gupta
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  3. Diego Villagomez
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  4. Malay Shah
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  5. Francesc Marti
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  6. Xiaonan Mei
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Contributions

Design of the work was contributed by GO, DV, RG. Analysis and interpretation of data were contributed by GO, DV, DD, XM, RG. Manuscript drafting and critical revision were contributed by GO, DV, DD, XM, FM, MG, RG. Final approval of the version to be published was contributed by GO, MG, MS, AA, SD, FS, KB, DV, DD, XM, FM, RG.

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Correspondence to Roberto Gedaly.

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Orozco, G., Gupta, M., Villagomez, D. et al. Predictors of Liver Failure in Non-Cirrhotic Patients Undergoing Hepatectomy. World J Surg 46, 3081–3089 (2022). https://doi.org/10.1007/s00268-022-06742-3

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