title: Does the presence of coronary artery disease impact perioperative outcomes following partial hepatectomy?
abstract: BACKGROUND
  Coronary artery disease (CAD) is often considered a contraindication to hepatectomy despite a lack of data to support this practice. The purpose of this study is to evaluate the impact of CAD on postoperative outcomes in patients undergoing hepatectomy.
  
  
  METHODS
  A total of 1,206 consecutive patients undergoing hepatectomy from August 1995 to June 2009 were included. Propensity matching was performed to identify differences in morbidity and mortality between patients with and without CAD. Subgroup analyses were performed to stratify patients based on the severity of CAD and the interval between coronary intervention and hepatectomy.
  
  
  RESULTS
  Of all patients, 138 (11.4%) had a diagnosis of CAD and were more likely to have a malignant diagnosis and other comorbid conditions including renal insufficiency, COPD, and diabetes. Matched patients with CAD had no significant differences in complication rates, with 2.2 and 5.8% of CAD patients experiencing a postoperative myocardial infarction or arrhythmia, respectively. Propensity matching failed to identify differences in mortality or morbidity. Subgroup analysis revealed similar rates of mortality and complications regardless of the severity of CAD or the time interval between coronary intervention and hepatectomy.
  
  
  CONCLUSIONS
  Despite the increased prevalence of major medical comorbidities, selected patients with CAD can safely undergo hepatectomy with acceptable rates of postoperative morbidity and mortality.
authors.affiliation: Department of Surgery, Duke University Medical Center, DUMC 3247, Durham, NC, 27710, USA, michael.lidsky@duke.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lidsky
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Barbas
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000150:complications*; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012189:Retrospective Studies; D012720:Severity of Illness Index