Early trends in serum phosphate and creatinine levels are associated with mortality following major hepatectomy.

Conference Paper

BACKGROUND: Mortality after major hepatectomy remains high and is frequently related to post-hepatectomy liver failure (PHLF). Other than pre-existing liver disease and a small future liver remnant, few patient factors or early postoperative indicators identify patients at elevated risk for PHLF and mortality. METHODS: Data on demographics, comorbidities, operative procedures and postoperative laboratory trends were reviewed for patients submitted to major hepatectomy (at least three Couinaud segments) for malignancy during 1998-2013. These factors were compared among patients who died within 90 days, survivors who met the 50-50 criteria and all remaining survivors. RESULTS: A total of 1528 patients underwent major hepatectomy during the study period. Of these, 947 had metastatic colorectal cancer and underwent resection of a median of four segments. Overall, 49 patients (3.2%) died within 90 days of surgery and 48 patients (3.1%) met the 50-50 criteria for PHLF; 30 of these patients survived 90 days. Operative blood loss was higher in patients who died within 90 days compared with survivors (1.0 l versus 0.5 l; P < 0.001). Despite equivalent perioperative resuscitation and urine output, non-survivors had higher creatinine and phosphate levels than survivors on postoperative day (PoD) 1 (1.1 mg/dl versus 0.9 mg/dl and 4.6 mg/dl versus 3.7 mg/dl, respectively; P < 0.001). CONCLUSIONS: Early trends in creatinine and phosphate (between the day of surgery and PoD 1) identify patients at risk for PHLF and mortality.

Full Text

Duke Authors

Cited Authors

  • Herbert, GS; Prussing, KB; Simpson, AL; D'Angelica, MI; Allen, PJ; DeMatteo, RP; Jarnagin, WR; Kingham, TP

Published Date

  • December 2015

Published In

Volume / Issue

  • 17 / 12

Start / End Page

  • 1058 - 1065

PubMed ID

  • 26385577

Pubmed Central ID

  • PMC4644357

Electronic International Standard Serial Number (EISSN)

  • 1477-2574

Digital Object Identifier (DOI)

  • 10.1111/hpb.12483

Conference Location

  • England