title: Factors in perioperative care that determine blood loss in liver surgery.
abstract: OBJECTIVE
  Excessive blood loss during liver surgery contributes to postoperative morbidity and mortality and the minimizing of blood loss improves outcomes. This study examines pre- and intraoperative factors contributing to blood loss and identifies areas for improvement.
  
  
  METHODS
  All patients who underwent elective hepatic resection between June 2007 and June 2009 were identified. Detailed information on the pre- and perioperative clinical course was analysed. Univariate and multivariate analyses were used to identify factors associated with intraoperative blood loss.
  
  
  RESULTS
  A total of 175 patients were studied, of whom 95 (54%) underwent resection of three or more segments. Median blood loss was 782 ml. Greater blood loss occurred during major resections and prolonged surgery and was associated with an increase in postoperative complications (P= 0.026). Peak central venous pressure (CVP) of >10 cm H(2)O was associated with increased blood loss (P= 0.01). Although no differences in case mix were identified, blood loss varied significantly among anaesthetists, as did intraoperative volumes of i.v. fluids and transfusion practices.
  
  
  CONCLUSIONS
  This study confirms a relationship between CVP and blood loss in hepatic resection. Intraoperative CVP values were higher than those described in other studies. There was variation in the intraoperative management of patients. Collaboration between surgical and anaesthesia teams is required to minimize blood loss and the standardization of intraoperative anaesthesia practice may improve outcomes following liver surgery.
authors.affiliation: Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK. stephen.mcnally@ed.ac.uk
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: McNally
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Revie
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Massie
authors.forename: Dermot W
authors.initials: DW
authors.lastname: McKeown
authors.forename: Rowan W
authors.initials: RW
authors.lastname: Parks
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wigmore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002496:Central Venous Pressure; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019990:Perioperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland; D065227:Transfusion Reaction; D055815:Young Adult