Pulmonary embolism after elective liver resection: a prospective analysis of risk factors.
OBJECTIVE
Impairment of clotting factors after liver resection (LR) is considered to protect from the risk of pulmonary embolism (PE). We aimed at formally investigating the risk of PE after elective LR.


METHODS
From 2007 to 2009, 410 consecutive patients were prospectively analyzed to assess the risk of postoperative PE after LR with a thoracic CT scan, with or without a CT pulmonary angiography (CTPA). All patients were on a standardized thromboprophylaxis regimen.


RESULTS
PE was diagnosed in 24 (6%) patients within the first 10 postoperative days. Comparison between the PE group (n=24) and the non-PE group (n=386) showed a similar rate of metastatic liver disease (25 vs. 31%, p=0.308) but higher rates of BMI ≥ 25 kg/m(2) (75 vs. 46%, p=0.006), major LR (79 vs. 45%, p=0.003) and normal or minimally fibrotic liver parenchyma (92 vs. 73%, p=0.05). No patients with PE had inherited or acquired coagulation disorders. The 90-day mortality rate was similar in the two groups (4% vs. 3%, p=0.77), but the median hospital stay was longer in the PE group (20(IQR 16-27) vs. 11(IQR 8-16) days, p=0.001). On multivariate analysis, the independent predictors for PE were a BMI ≥ 25 kg/m(2) (adj. OR 5.27), major LR (adj. OR 3.13) and normal or minimally fibrotic liver parenchyma (adj. OR 4.21).


CONCLUSIONS
In addition to patient characteristics (high BMI), major resection and normal liver parenchyma increase the risk of PE after LR. This suggests that specific thromboembolic mechanisms are involved in liver regeneration and advocates more aggressive thromboprophylaxis in the high-risk groups.
Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Hospital Beaujon, University Paris 7, Clichy, France.
Emmanuel
E
Melloul
Fédérica
F
Dondéro
Valérie
V
Vilgrain
Dimitri A
DA
Raptis
Catherine
C
Paugam-Burtz
Jacques
J
Belghiti
D051722:ADAM Proteins / Q000032:analysis / Q000502:physiology; D000071120:ADAMTS13 Protein; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human