Hypophosphataemia after major hepatectomy and the risk of post-operative hepatic insufficiency and mortality: an analysis of 719 patients.
BACKGROUND
Hypophosphataemia after a hepatectomy suggests hepatic regeneration. It was hypothesized that the absence of hypophosphataemia is associated with post-operative hepatic insufficiency (PHI) and complications.


METHODS
Patients who underwent a major hepatectomy from 2000-2012 at a single institution were identified. Post-operative serum phosphorus levels were assessed. Primary outcomes were PHI (peak bilirubin >7 mg/dl), major complications, and 30- and 90-day mortality.


RESULTS
Seven hundred and nineteen out of 749 patients had post-operative phosphorus levels available. PHI and major complications occurred in 63 (8.8%) and 169 (23.5%) patients, respectively. Thirty- and 90-day mortality were 4.0% and 5.4%, respectively. The median phosphorus level on post-operative-day (POD) 2 was 2.2 mg/dl; 231 patients (32.1%) had phosphorus >2.4 on POD2. Patients with POD2 phosphorus >2.4 had a significantly higher incidence of PHI, major complications and mortality. On multivariate analysis, POD2 phosphorus >2.4 remained a significant risk factor for PHI [(hazard ratio HR):1.78; 95% confidence interval (CI):1.02-3.17; P = 0.048], major complications (HR:1.57; 95%CI:1.02-2.47; P = 0.049), 30-day mortality (HR:2.70; 95%CI:1.08-6.76; P = 0.034) and 90-day mortality (HR:2.51; 95%CI:1.03-6.15; P = 0.044). Similarly, patients whose phosphorus level reached nadir after POD3 had higher PHI, major complications and mortality.


CONCLUSIONS
Elevated POD2 phosphorus levels >2.4 mg/dl and a delayed nadir in phosphorus beyond POD3 are associated with increased post-operative hepatic insufficiency, major complications and early mortality. Failure to develop hypophosphataemia within 72 h after a major hepatectomy may reflect insufficient liver remnant regeneration.
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Malcolm H
MH
Squires
Gregory C
GC
Dann
Neha L
NL
Lad
Sarah B
SB
Fisher
Benjamin M
BM
Martin
David A
DA
Kooby
Juan M
JM
Sarmiento
Maria C
MC
Russell
Kenneth
K
Cardona
Charles A
CA
Staley
Shishir K
SK
Maithel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005845:Georgia; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D048550:Hepatic Insufficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006801:Humans; D017674:Hypophosphatemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008115:Liver Regeneration; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010758:Phosphorus / Q000097:blood; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D010758:Phosphorus