title: Predictors of peri-opertative morbidity and liver dysfunction after hepatic resection in patients with chronic liver disease.
abstract: BACKGROUND
  Hepatic resection in patients with chronic liver disease (CLD) is associated with a risk of post-operative liver failure and higher morbidity than patients without liver disease. There is no universal risk stratification scheme for CLD patients undergoing resection.
  
  
  OBJECTIVE
  The aim of the present study was to evaluate the association between routine pre-operative laboratory investigations, model for end-stage liver disease (MELD), indocyanine green retention at 15 min (ICG15) and post-operative outcomes in CLD patients undergoing liver resection.
  
  
  METHODS
  A retrospective review of patients undergoing resection for hepatocellular carcinoma (HCC) at the University Health Network was preformed. ICG15 results, pre- and post-operative laboratory results were obtained from clinical records. Adjusted odds ratios (AOR) were calculated for associations between pre-operative factors and post-operative outcomes using multivariate logistic regression adjusting for patient age and number of segments resected.
  
  
  RESULTS
  Between 2001 and 2005, 129 CLD patients underwent surgical resection for HCC. Procedures included 51 (40%) resections of ≤ 2 segments, 52 (40%) hemihepatectomies and 25 (19%) extended hepatic resections. Thirty- and 90-day post-operative mortality was 1.6% and 4.1%, respectively. Prolonged (>10 days) hospital length of stay (LOS) was independently associated with an ICG15 >15% {AOR [95% confidence interval (CI)]= 8.5 (1.4-51)} and an international normalized ratio (INR) > 1.2 [AOR (95% CI) = 5.0 (1.4-18.6)]. An ICG15 > 15% and MELD score were independent predictors of prolonged LOS. An ICG15 > 15% was also independently associated with MELD > 20 on post-operative day 3 [AOR (95% CI) = 24.3 (1.8-319)].
  
  
  CONCLUSIONS
  Elevated ICG retention was independently associated with post-operative liver dysfunction and morbidity. The utility of ICG in combination with other biochemical measures to predict outcomes after hepatic resection in CLD patients requires further prospective study.
authors.affiliation: Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Elisa
authors.initials: E
authors.lastname: Greco
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Nanji
authors.forename: Irvin L
authors.initials: IL
authors.lastname: Bromberg
authors.forename: Shimul
authors.initials: S
authors.lastname: Shah
authors.forename: Alice C
authors.initials: AC
authors.lastname: Wei
authors.forename: Carol-Anne
authors.initials: CA
authors.lastname: Moulton
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cleary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007208:Indocyanine Green; D007902:Length of Stay; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green