title: Extended hepatic resection: a 6-year retrospective study of risk factors for perioperative mortality.
abstract: BACKGROUND
  Extended hepatic resection (more than four liver segments) is a major operative procedure that is associated with significant risk. The purpose of this study was to assess the impact of perioperative variables on in-hospital mortality after extended hepatectomy.
  
  
  METHODS
  Consecutive patients who underwent extended hepatic resection were studied. The prognostic value of 29 perioperative variables was evaluated using in-hospital mortality as the endpoint. For each variable, the odds ratio (95% confidence interval) for in-hospital mortality was calculated. Those variables with a lower confidence limit > 1 were considered important risk factors. The population was stratified into categories of patients having the same number of risk factors, and mortality was estimated for each group. These data were used to develop a risk assessment algorithm.
  
  
  RESULTS
  There were 14 deaths (6%) in 226 patients. Three preoperative variables (cholangitis, creatinine > 1.3 mg/dL, and total bilirubin > 6 mg/dL) and two operative variables (blood loss > 3 L and vena caval resection) appear to be important factors for in-hospital mortality. The mortality associated with the presence of any two of the five factors was 100% (5 of 5), and the mortality associated with the absence of these factors was 3% (6 of 191).
  
  
  CONCLUSIONS
  Perioperative evaluation of patients undergoing extended hepatic resection should include the quantitation of mortality risk factors. The combination of any two factors among preoperative cholangitis, elevated serum creatinine, elevated serum bilirubin, high operative blood loss, and vena cava resection may carry a high mortality risk. These results require prospective validation.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: J
authors.initials: J
authors.lastname: Melendez
authors.forename: E
authors.initials: E
authors.lastname: Ferri
authors.forename: M
authors.initials: M
authors.lastname: Zwillman
authors.forename: M
authors.initials: M
authors.lastname: Fischer
authors.forename: R
authors.initials: R
authors.lastname: DeMatteo
authors.forename: D
authors.initials: D
authors.lastname: Leung
authors.forename: W
authors.initials: W
authors.lastname: Jarnagin
authors.forename: Y
authors.initials: Y
authors.lastname: Fong
authors.forename: L H
authors.initials: LH
authors.lastname: Blumgart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D016063:Blood Loss, Surgical; D002648:Child; D002761:Cholangitis / Q000150:complications; D003404:Creatinine / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D014684:Venae Cavae / Q000601:surgery
chemical_list: D003404:Creatinine; D001663:Bilirubin