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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 Daniele Pinna and Gian Luca Grazi |
Bologna, Italy
Author Affiliations: General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy (Filicori F, Zanello M, Ercolani G, Sacchetti F and Pinna AD); Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA (Filicori F and Keutgen XM); Department of Emergency Surgery, Maggiore Hospital, L.go Nigrisoli 2, 40133 Bologna, Italy (Di Saverio S); Hepato-Biliary Surgery Unit, Istituto Nazionale Tumori Regina Elena, Via Elio Chianesi, 53, 00144 Roma, Italy (Grazi GL)
Corresponding Author: Filippo Filicori, MD, Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA (Tel: 1-212-746-5187; Fax: 1-212-746- 9948; Email: fif2003@med.cornell.edu) |
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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 ALT<188 U/L on postoperative day 1 were predictive of death from hepatic failure in the postoperative period. Age >65 years, HCV, reoperation, and renal failure were significant predictors of overall intra-hospital 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 <188 U/L on postoperative day 1 were associated with death from hepatic failure in our patient population.
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