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News

Morbidity and mortality after liver resection

This month's Journal of the American College of Surgeons evaluates factors associated with morbidity and mortality after liver resection.

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Liver resection is performed with increasing frequency.

Nearly all of the published information on operative mortality and morbidity rates associated with liver resection is derived from studies that rely on retrospective data.

The data was usually collected from single centers.

Dr Kenneth Tanabe and colleagues from Boston used audited multiinstitutional data from the private sector of the Patient Safety in Surgery Study.

The research team characterized complications after liver resection and identified variables that are associated with 30-day morbidity and mortality.

The team prospectively collected data on liver resection patients from 14 hospitals.

The team used National Surgical Quality Improvement Program's methodology.

A complication occurred in 23% of patients within 30 days
Journal of the American College of Surgeons

Rates of occurrence of 21 defined postoperative complications were measured.

Bivariate analyses and stepwise logistic regression were used to identify factors associated with 30-day morbidity and mortality.

The researchers observed that at least 1 complication occurred in 23% of patients within 30 days.

Stepwise logistic regression identified several preoperative factors associated with morbidity.

The team showed that serum albumin, serum glutamic oxaloacetic transaminase over 40, and previous cardiac operation were associated with morbidity.

Operative work relative value unit, and history of severe chronic obstructive pulmonary disease.

Mortality within 30 days was observed in 3% of patients.

The researchers found that factors associated with mortality included male gender, and American Society of Anesthesiologists class 3 or higher.

Presence of ascites, dyspnea, and severe chronic obstructive pulmonary disease also were associated with mortality.

Less than 1% of patients without any complications died, compared with 9% of patients with at least 1 complication.

Dr Tanabe's team comments, "Prospective, standardized, audited, multiinstitutional data were analyzed to identify several preoperative and intraoperative factors associated with morbidity and mortality after liver resection."

"These factors should be considered during patient selection and perioperative management."

J Am Coll Surg 2007: 204(6): 1284-92
27 June 2007

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