Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy

Filippo Filicori, Xavier M. Keutgen, Matteo Zanello, Giorgio Ercolani, Salomone Di Saverio, Federico Sacchetti, Antonio Pinna Daniele, Gian Luca Grazi

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Abstract

Background: Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. Methods: One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. Results: The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT65 years, HCV, reoperation, and renal failure were significant predictors of overall intrahospital mortality on multivariate analysis. Conclusions: The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level

Original languageEnglish
Pages (from-to)507-512
Number of pages6
JournalHepatobiliary and Pancreatic Diseases International
Volume11
Issue number5
DOIs
Publication statusPublished - 2012

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Keywords

  • Bilirubin
  • Hepatectomy
  • Liver diseases
  • Liver failure
  • Postoperative complications
  • Prothrombin time

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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