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The impact of post-hepatectomy liver failure on mortality: a population-based study
Karolinska Inst, Inst Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden; Karolinska Univ Hosp, Ctr Digest Dis, Dept Surg, Stockholm, Sweden.ORCID iD: 0000-0003-4930-549X
Linköping Univ Hosp, Cty Council Östergötland, Dept Surg & Clin & Expt Med, Linköping, Sweden.
Sahlgrens Univ Hosp, Gothenburg, Sweden.
Skånes Univ Hosp, Lund, Sweden.
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2018 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 10-11, p. 1335-1339Article in journal (Refereed) Published
Abstract [en]

Background: Post-hepatectomy liver failure (PHLF) is considered a main reason for death after major hepatectomy. The reported PHLF-related mortality differs largely and the data mainly originate from single centers.

Aim: A retrospective, population-based register study was designed to evaluate the impact of PHLF on 90-day mortality after hepatectomy.

Method: All patients who underwent liver resection in Sweden between 2005 and 2009 were retrospectively identified using the Swedish Hospital Discharge Registry. 30- and 90-day mortality were identified by linkage to the Registry of Causes of Death. Additional clinical data were obtained from the medical charts in all seven university hospitals in Sweden. PHLF was defined according to Balzan criteria (Bilirubin >50 µg/L and international normalized ratio >1.5) on postoperative day 5.

Results: A total of 2461 liver resections were performed (2194 in university hospitals). 30- and 90-day mortality were 1.3% and 2.5%, respectively. 90-day mortality at university hospitals was 2.1% (n = 46). In 41% (n = 19) of these patients, PHLF alone or in combination with multi-organ failure was identified as cause of death. Between the PHLF and non-PHLF group, there was no significant difference regarding age, sex, American Society of Anesthesiologists-classification, or preoperative chemotherapy. Cholangiocarcinoma as indication for surgery, need for vascular reconstruction and an extended resection were significantly overrepresented in the PHLF-group. Between groups, the incidence of 50:50 criteria differed significantly already on postoperative day 3.

Conclusion: Overall mortality is very low after hepatectomy in Sweden. PHLF represents the single most important cause of death even in a population-based setting.

Place, publisher, year, edition, pages
2018. Vol. 53, no 10-11, p. 1335-1339
Keywords [en]
Post-hepatectomy liver failure, population-based, major hepatic resection, post-operative mortality, hepatectomy, liver dysfunction
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:uu:diva-377722DOI: 10.1080/00365521.2018.1501604ISI: 000457980900027PubMedID: 30345846OAI: oai:DiVA.org:uu-377722DiVA, id: diva2:1294796
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-03-08Bibliographically approved

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