Morbidity of major hepatic resections: a 100-case prospective study.

Objective: To assess the morbidity and its main risk factors after major hepatic resection.

Design: Retrospective study of prospectively collected data.

Setting: University hospital, France.

Subjects: 100 consecutive patients who underwent major hepatic resections, 1989-95.

Interventions: Major hepatic resection, defined as resection involving 3 or more segments according to Couinaud's classification, in all cases.

Main Outcome Measures: All complications that affected outcome or prolonged hospital stay. Risk factors identified by univariate and multivariate analysis.

Results: 45 patients developed at least 1 complication and 7 died. The most common complications were: pleural effusion (n = 21), hepatic failure (n = 12), and ascites (n = 9). Univariate analysis showed that the following variables were significantly related to the morbidity: age >55 years, American Society of Anesthesiologists (ASA) grade II or more, bilirubin >80 micromol/L, alkaline phosphatase activity more than double the reference range, malignant tumours, abnormal liver parenchyma, simultaneous surgical procedures, operative time >4 hours, and perioperative blood transfusion > or =600 ml. The extent of resection did not correlate with postoperative complications. Multivariate analysis showed that volume of blood transfusion > or =600 ml and simultaneous surgical procedures were the most important independent risk factors for complicated outcome.

Conclusions: The morbidity associated with major hepatic resections remains high, and the main determinants of outcome are intraoperative surgeon-related factors.