Perioperative predictors of morbidity following hepatic resection for neoplasm. A multivariate analysis of a single surgeon experience with 105 patients.
OBJECTIVE
Factors that predict mortality or morbidity risk in consecutive hepatic resections for neoplasm were examined, with controlled variables of surgical technique and experience.


BACKGROUND
Hepatic resection has become the therapy of choice for the management of metastatic or primary neoplasms of the liver. Although mortality for this procedure has steadily decreased, associated morbidity remains high.


METHODS
One hundred five patients undergoing hepatic resection for malignancy over a 4-year period by a single surgeon to identify preoperative, intraoperative, or postoperative predictors of morbid outcomes were studied. Variables were analyzed using multiple regression in a stepwise, logistic model.


RESULTS
Sixty-day hospital mortality was 2.8%, with morbidity occurring in 33%. A significant preoperative predictor of morbidity was serum bilirubin (p > 0.005). Notably, preoperative renal function, or medical illness, did not increase morbid risk. Operative variables increasing risk included extent of resection, blood loss, and operative time (p > 0.005).


CONCLUSIONS
Complex hepatic resection can be performed with low mortality, and serum bilirubin is the single most powerful predictor of postoperative complication.
Sitzmann
J V
JV
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Greene
P S
PS
D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors
D001663:Bilirubin