Hypophosphatemia and recovery of post-hepatectomy liver insufficiency.
BACKGROUND
Hypophosphatemia (HP) is frequent following liver resection, and thought to represent use of phosphate during liver regeneration. We sought to evaluate the association of post-hepatectomy HP with liver insufficiency and recovery.


METHODS
Liver resections were retrospectively reviewed from 2009 to 2012 at a single institution. We explored the relationship between HP (defined as serum phosphate ≤0.65 mmol/L), occurrence of initial liver insufficiency (ILI) [bilirubin >50 µmol/L, international normalized ratio (INR) >1.7 within 72 hours of surgery] and in-hospital recovery of ILI. Secondary outcomes included 30-day post-operative major morbidity (Clavien grade 3 and 4 complications), mortality, and re-admission.


RESULTS
Among 402 patients, 223 (55.5%) experienced HP and 64 (15.9%) met our definition of ILI, of which 53 (82.8%) recovered. Length of stay, 30-day post-operative major morbidity, mortality, and re-admission were similar between patients with and without HP. Among patients with ILI, 44 (68.8%) experienced HP. Following ILI, patients with HP recovered more often than those with NP (90.9% vs. 65.0%; P=0.03).


CONCLUSIONS
In patients who experience post-hepatectomy ILI, HP is associated with improved recovery, potentially indicating more efficient liver regeneration. Further studies should explore the usefulness of post-hepatectomy HP as an early prognostic factor of recovery from ILI.
1 Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ; 2 Division of General Surgery, University of Toronto, Toronto, Canada ; 3 Faculty of Medicine, University of Toronto, Toronto, Canada.
Julie
J
Hallet
1 Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ; 2 Division of General Surgery, University of Toronto, Toronto, Canada ; 3 Faculty of Medicine, University of Toronto, Toronto, Canada.
Paul J
PJ
Karanicolas
1 Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ; 2 Division of General Surgery, University of Toronto, Toronto, Canada ; 3 Faculty of Medicine, University of Toronto, Toronto, Canada.
Francis S W
FS
Zih
1 Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ; 2 Division of General Surgery, University of Toronto, Toronto, Canada ; 3 Faculty of Medicine, University of Toronto, Toronto, Canada.
Eva
E
Cheng
1 Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ; 2 Division of General Surgery, University of Toronto, Toronto, Canada ; 3 Faculty of Medicine, University of Toronto, Toronto, Canada.
Julia
J
Wong
1 Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ; 2 Division of General Surgery, University of Toronto, Toronto, Canada ; 3 Faculty of Medicine, University of Toronto, Toronto, Canada.
Sherif
S
Hanna
1 Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ; 2 Division of General Surgery, University of Toronto, Toronto, Canada ; 3 Faculty of Medicine, University of Toronto, Toronto, Canada.
Natalie G
NG
Coburn
1 Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada ; 2 Division of General Surgery, University of Toronto, Toronto, Canada ; 3 Faculty of Medicine, University of Toronto, Toronto, Canada.
Calvin H L
CH
Law
Liver resection; hepatectomy; hypophosphatemia (HP); liver failure; liver insufficiency; recovery