title: Analysis of risk factors for hyperbilirubinemia occurring after hepatectomy.
abstract: BACKGROUND
  To further improve the outcomes of liver resection, it is important to identify and prevent the causes of the hyperbilirubinemia occurring after hepatectomy and postoperative liver failure.
  
  
  METHODS
  Between 2004 and 2009, 591 consecutive patients underwent a hepatectomy at our center. Twenty-two patients who developed hyperbilirubinemia (postoperative total bilirubin over 5 mg/dL) after hepatectomy were classified as Hi-Bi group and another 569 whose total bilirubin did not increase beyond 5 mg/dL were classified as non-Hi-Bi group.
  
  
  RESULTS
  A preoperative prothrombin test of less than 80% and a blood loss of more than 1000 mL were identified as independent risk factors for the Hi-Bi group by multivariate analysis. The hyperbilirubinemia of 16 cases improved, while that of 6 cases was prolonged. One of these patients died of liver failure without responding to treatment. The mortality rate for postoperative liver failure in this study was 0.16% (1/591).
  
  
  CONCLUSIONS
  It is important to reduce the length of surgery and intraoperative blood loss to prevent hyperbilirubinemia after hepatectomy. Additionally, decision-making using our algorithm and full examination of the accurate evaluation results, including those for prothrombin time, residual liver function and liver damage, can help reduce the development of hyperbilirubinemia.
authors.affiliation: The Department of General Surgery, Hokkaido University, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan. fukumori58@hotmail.com
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fukumori
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Hideki
authors.initials: H
authors.lastname: Yokoo
authors.forename: Munenori
authors.initials: M
authors.lastname: Tahara
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.forename: Michiaki
authors.initials: M
authors.lastname: Matsushita
authors.forename: Satoru
authors.initials: S
authors.lastname: Todo
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends