title: Systematic review and meta-analysis of steatosis as a risk factor in major hepatic resection.
abstract: BACKGROUND
  The risk of major hepatic resection in patients with hepatic steatosis remains controversial. A meta-analysis was performed to establish the best estimate of the impact of steatosis on patient outcome following major hepatic surgery.
  
  
  METHODS
  A systematic search was performed following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Risk ratios (RRs) for complication and mortality rates were calculated for patients with no, less than 30 per cent and at least 30 per cent steatosis, and a meta-analysis was carried out.
  
  
  RESULTS
  Of six observational studies identified, four including a total of 1000 patients were subjected to meta-analysis; two others were tabulated separately. Compared with patients without steatosis, those with less than 30 per cent and at least 30 per cent steatosis had a significantly increased risk of postoperative complications, with a RR of 1.53 (95 per cent confidence interval (c.i.) 1.27 to 1.85) and 2.01 (1.66 to 2.44) respectively. Patients with at least 30 per cent steatosis had an increased risk of postoperative death (RR 2.79, 95 per cent c.i. 1.19 to 6.51).
  
  
  CONCLUSIONS
  Patients with steatosis had an up to twofold increased risk of postoperative complications, and those with excessive steatosis had an almost threefold increased risk of death.
authors.affiliation: Department of Surgery and Vascular Biology Program, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: V E
authors.initials: VE
authors.lastname: de Meijer
authors.forename: B T
authors.initials: BT
authors.lastname: Kalish
authors.forename: M
authors.initials: M
authors.lastname: Puder
authors.forename: J N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D005234:Fatty Liver / Q000209:etiology* / Q000401:mortality; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome