Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy.
BACKGROUND
Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients.


METHODS
One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure.


RESULTS
The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT<188 U/L on postoperative day 1 were predictive of death from hepatic failure in the postoperative period. Age >65 years, HCV, reoperation, and renal failure were significant predictors of overall intra-hospital mortality on multivariate analysis.


CONCLUSIONS
The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level <188 U/L on postoperative day 1 were associated with death from hepatic failure in our patient population.
General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. fif2003@med.cornell.edu
Filippo
F
Filicori
Xavier M
XM
Keutgen
Matteo
M
Zanello
Giorgio
G
Ercolani
Salomone
S
Di Saverio
Federico
F
Sacchetti
Antonio Daniele
AD
Pinna
Gian Luca
GL
Grazi
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D017093:Liver Failure / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis
D000410:Alanine Transaminase; D001663:Bilirubin