The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection.
The risk of postoperative adverse events in patients with underlying cardiac disease undergoing major hepatectomy remains poorly characterized.



The NSQIP database was used to identify patients undergoing hemihepatectomy and trisectionectomy. Patient characteristics and postoperative outcomes were evaluated.



From 2005 to 2012, 5227 patients underwent major hepatectomy. Of those, 289 (5.5%) had prior major cardiac disease: 5.6% angina, 3.1% congestive heart failure, 1% myocardial infarction, 54% percutaneous coronary intervention, and 46% cardiac surgery. Thirty-day mortality was higher in patients with cardiac comorbidity (6.9% vs. 3.7%, P = 0.008), including the incidence of postoperative cardiac arrest requiring cardiopulmonary resuscitation (3.8% vs. 1.2%, P = 0.001) and myocardial infarction (1.7% vs. 0.4%, P = 0.011). Multivariate analysis revealed that functional impairment, older age, and malnutrition, but not cardiac comorbidity, were significant predictors of 30-day mortality. However, prior percutaneous coronary intervention was independently associated with postoperative cardiac arrest (OR 2.999, P = 0.008).



While cardiac comorbidity is not a predictor of mortality after major hepatectomy, prior percutaneous coronary intervention is independently associated with postoperative cardiac arrest. Careful patient selection and preoperative optimization is fundamental in patients with prior percutaneous coronary intervention being considered for major hepatectomy as restrictive fluid management and low central venous pressure anesthesia may not be tolerated well by all patients.
Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, CA, USA.
Thuy B
TB
Tran
Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, CA, USA.
David J
DJ
Worhunsky
Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, CA, USA.
David A
DA
Spain
Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, CA, USA.
Monica M
MM
Dua
Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, CA, USA.
Brendan C
BC
Visser
Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, CA, USA.
Jeffrey A
JA
Norton
Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, CA, USA. Electronic address: gpoultsides@stanford.edu.
George A
GA
Poultsides
D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006331:Heart Diseases / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000009:adverse effects; D014690:Venous Pressure / Q000187:drug effects
D014662:Vasoconstrictor Agents