title: Abnormal coagulation profile after hepatic resection: the effect of chronic hepatic disease and implications for epidural analgesia.
abstract: OBJECTIVE
  To evaluate the effect of chronic hepatic disease on postoperative coagulation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Operating room with postoperative inpatient followup.
  
  
  METHODS
  The records of 153 patients who underwent elective open hepatic resection were reviewed. The perioperative coagulation profile of each patient was assessed. The postoperative period was subdivided into the early [postoperative day (POD) 0-3] and late (POD 4 - POD 7) periods.
  
  
  RESULTS
  68 (44.4%) patients had chronic hepatic disease and 50 (32.7%) had cirrhosis. Eighty-four (54.9%) patients had an abnormal early postoperative coagulation profile and 46 (30.1%) had an abnormal late postoperative coagulation profile. The proportion of patients having an abnormal coagulation profile peaked on POD 2, at 39.2%. Only 5.3% of patients had an abnormal coagulation profile on POD 7. The independent predictors of abnormal early and late postoperative coagulation profiles were preexisting hepatic cirrhosis [early: odds ratio (OR) 3.73(1.49 - 9.29), late: OR 6.84(2.11 - 22.21)], abnormal preoperative coagulation profile [early: OR 9.68 (1.97 - 47.5), late: OR 11.71 (3.61- 38.02)], major hepatic resection [early: OR 4.15 (1.66 - 10.4), late: OR 5.43 (1.68 - 17.47)], and intraoperative blood loss.
  
  
  CONCLUSIONS
  An abnormal postoperative coagulation profile after hepatic surgery is common in a patient population with chronic hepatic disease.
authors.affiliation: Department of Anaesthesiology, Singapore General Hospital, Outram Rd., Singapore 169608, Republic of Singapore.
authors.forename: Flora Shiyi
authors.initials: FS
authors.lastname: Yuan
authors.forename: Shin Yi
authors.initials: SY
authors.lastname: Ng
authors.forename: Kok Yuen
authors.initials: KY
authors.lastname: Ho
authors.forename: Ser Yee
authors.initials: SY
authors.lastname: Lee
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Chung
authors.forename: Ruban
authors.initials: R
authors.lastname: Poopalalingam
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000209:etiology*; D016063:Blood Loss, Surgical; D002908:Chronic Disease; D000075202:Contraindications; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors