title: Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS).
abstract: BACKGROUND
  A standardized definition of post-hepatectomy haemorrhage (PHH) has not yet been established.
  
  
  METHODS
  An international study group of hepatobiliary surgeons from high-volume centres was convened and a definition of PHH was developed together with a grading of severity considering the impact on patients' clinical management.
  
  
  RESULTS
  The definition of PHH varies strongly within the hepatic surgery literature. PHH is defined as a drop in haemoglobin level > 3 g/dl post-operatively compared with the post-operative baseline level and/or any post-operative transfusion of packed red blood cells (PRBC) for a falling haemoglobin and/or the need for radiological intervention (such as embolization) and/or re-laparotomy to stop bleeding. Evidence of intra-abdominal bleeding should be obtained by imaging or blood loss via the abdominal drains if present. Transfusion of up to two units of PRBC is considered as being Grade A PHH. Grade B PHH requires transfusion of more than two units of PRBC, whereas the need for invasive re-intervention such as embolization and/ or re-laparotomy defines Grade C PHH.
  
  
  CONCLUSIONS
  The proposed definition and grading of severity of PHH enables valid comparisons of results from different studies. It is easily applicable in clinical routine and should be applied in future trials to standardize reporting of complications.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
authors.forename: Nuh N
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authors.lastname: Maddern
authors.forename: Moritz
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authors.lastname: Figueras
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authors.forename: Yukihiro
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authors.lastname: Yokoyama
authors.forename: Mark
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authors.lastname: Brooke-Smith
authors.forename: Michael
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authors.lastname: Crawford
authors.forename: Christopher
authors.initials: C
authors.lastname: Christophi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D015415:Biomarkers / Q000097:blood; D032921:Consensus; D004621:Embolization, Therapeutic; D017707:Erythrocyte Transfusion; D006454:Hemoglobins / Q000032:analysis; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015588:Observer Variation; D019106:Postoperative Hemorrhage / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D011237:Predictive Value of Tests; D012086:Reoperation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D009626:Terminology as Topic
chemical_list: D015415:Biomarkers; D006454:Hemoglobins