title: Preoperative Serum Bilirubin and Lactate Levels Predict Postoperative Morbidity and Mortality in Liver Surgery: A Single-Center Evaluation.
abstract: OBJECTIVE
  In spite of huge developments in liver surgery during the last decades, morbidity and mortality continue to pose problems in this field. The aim of this study was to identify preoperative predictors for postoperative mortality and morbidity in liver surgery.
  
  
  METHODS
  In a single-center study, an extensive analysis of a prospective database, including clinical criteria and laboratory tests of patients undergoing liver surgery between July 2007 and July 2012 was performed. Cutoff values of selected laboratory tests were calculated.
  
  
  RESULTS
  In all, 337 patients were included in the study. Univariate analysis showed a statistically significant association of preoperative bilirubin, lactate, hemoglobin levels, platelet count, and prothrombin time with postoperative morbidity and mortality. Multivariate analysis revealed preoperatively elevated serum bilirubin and lactate levels as independent predictors for increased postoperative morbidity and mortality after liver surgery.
  
  
  CONCLUSIONS
  The identified laboratory values showed a statistically significant association with postoperative morbidity and mortality in liver surgery and might be helpful in preoperative patient selection.
authors.affiliation: Department of Surgery, Technische Universität München, Munich, Germany Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany Carina.Riediger@uniklinikum-dresden.de.
authors.forename: C
authors.initials: C
authors.lastname: Riediger
authors.affiliation: Department of Surgery, Technische Universität München, Munich, Germany Department of Surgery, Krankenhaus Bad Cannstatt, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: M W
authors.initials: MW
authors.lastname: Mueller
authors.affiliation: Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hapfelmeier
authors.affiliation: Department of Surgery, Technische Universität München, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Bachmann
authors.affiliation: Department of Surgery, Technische Universität München, Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Friess
authors.affiliation: Department of Surgery, Technische Universität München, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kleeff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008107:Liver Diseases / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019344:Lactic Acid; D001663:Bilirubin
keywords: Liver surgery; bilirubin; lactate; postoperative morbidity; postoperative mortality; preoperative predictors