title: Risk factors for major morbidity after liver resection for hepatocellular carcinoma.
abstract: BACKGROUND
  Bile leakage, and organ and/or space surgical-site infection (SSI) are common causes of major morbidity after partial hepatectomy for hepatocellular carcinoma (HCC). The purpose of this study was to analyse risk factors for major morbidity and to explore strategies for its reduction after partial hepatectomy for HCC.
  
  
  METHODS
  Risk factors for bile leakage and organ/space SSI were analysed in patients who underwent partial hepatectomy for HCC between 2001 and 2010. The causes, management and outcomes of intractable bile leakage requiring endoscopic therapy or percutaneous transhepatic biliary drainage were analysed. In addition, causative bacteria, outcomes and characteristics of organ/space SSI were investigated. Risk factors were identified using multivariable analysis.
  
  
  RESULTS
  Some 359 patients were included in the analysis. The prevalence of bile leakage and organ/space SSI was 12·8 and 8·6 per cent respectively. Repeat hepatectomy and an operating time of at least 300 min were identified as independent risk factors for bile leakage. The main causes of intractable bile leakage were latent strictures of the biliary system caused by previous treatments for HCC and intraoperative injury of the hepatic duct during repeat hepatectomy. Independent risk factors for organ/space SSI were repeat hepatectomy and bile leakage. Methicillin-resistant Staphylococcus aureus was detected more frequently in organ/space SSI after repeat hepatectomy than after initial partial hepatectomy.
  
  
  CONCLUSIONS
  Repeat hepatectomy and prolonged surgery were identified as risk factors for bile leakage after liver resection for HCC. Bile leakage and repeat hepatectomy increased the risk of organ/space SSI.
authors.affiliation: Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan. sada@md.okayama-u.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Sadamori
authors.forename: T
authors.initials: T
authors.lastname: Yagi
authors.forename: S
authors.initials: S
authors.lastname: Shinoura
authors.forename: Y
authors.initials: Y
authors.lastname: Umeda
authors.forename: R
authors.initials: R
authors.lastname: Yoshida
authors.forename: D
authors.initials: D
authors.lastname: Satoh
authors.forename: D
authors.initials: D
authors.lastname: Nobuoka
authors.forename: M
authors.initials: M
authors.lastname: Utsumi
authors.forename: T
authors.initials: T
authors.lastname: Fujiwara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D019072:Antibiotic Prophylaxis; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D015984:Causality; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control