title: Morbidity and mortality and predictors of outcome following hepatectomy at a Saudi tertiary care center.
abstract: BACKGROUND
  Hepatic resection is a major surgical procedure. Data on outcomes of hepatectomy in Saudi Arabia are scarce.
  
  
  OBJECTIVE
  To measure morbidity and mortality and assess predictors of outcome after hepatectomy.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  Tertiary care center in Saudi Arabia with well established hepatobiliary surgery unit.
  
  
  METHODS
  All patients undergoing liver resection in our institute during 2006-2014. Data were analyzed by Kaplan-Meier survival analysis.
  
  
  METHODS
  Postoperative morbidity and 90-day mortality. Secondary outcomes were risk factors associated with increased morbidity and mortality.
  
  
  RESULTS
  Data on 77 resections were collected; 56 patients (72.7%) had a malignant etiology, mainly colorectal liver metastases and hepatocellular carcinoma (45.5% and 14.3% respectively). Complications developed following 30 resections (39.0%), with the majority being Clavien grades I-III. In the univariate analysis, predicting factors were the total bilirubin level preoperatively, operative time, extent of resection (i.e., major resection), use of epidural anesthesia, and postoperative liver dysfunction. In the multivariate analysis, the Schindl liver dysfunction score showed the strongest correlation with the development of complications (P=.006). The 90-day postoperative mortality was 5.2% (4/77 patients); 3 patients fulfilled the 50:50 liver dysfunction criteria. Significant predictors were concurrent intra-abdominal surgery, postoperative liver dysfunction, and multiple complications.
  
  
  CONCLUSIONS
  Factors that predicted development of complications were elevated total bilirubin level preoperatively, operative time, extent of the resection, use of epidural anesthesia and a postoperative need for blood transfusion. Liver resection is a safe and feasible option at our center.
  
  
  CONCLUSIONS
  The small number of indications for resection and consequent reduction in variety of risk factors limited ability to make inferences. Additionally, only a handful of cases were performed laparoscopically.
authors.forename: Faisal
authors.initials: F
authors.lastname: Al-Alem
authors.forename: Rafif Essam
authors.initials: RE
authors.lastname: Mattar
authors.forename: Ola Abdelmonem
authors.initials: OA
authors.lastname: Fadl
authors.forename: Abdulsalam
authors.initials: A
authors.lastname: Alsharabi
authors.forename: Faisal
authors.initials: F
authors.lastname: Al-Saif
authors.affiliation: Dr. Mazen Hassanain, Department of General Surgery,, College of Medicine,, King Saud University,, Riyadh 11466, Saudi Arabia, Department of Oncology,, McGill University, Montreal,, Quebec, Canada, mhassanain@ksu.edu.sa, ORCID: http://orcid.org/0000- 0002-2441-5142.
authors.forename: Mazen
authors.initials: M
authors.lastname: Hassanain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000503:physiopathology / Q000601:surgery; D008113:Liver Neoplasms / Q000097:blood / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001663:Bilirubin