Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience |
| |
| Institution: | 1. Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco;2. Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco;3. Faculty of Medicine, Mohammed V University, and Anesthesiology and Intensive Care Department, Ibn Sina Hospital, Rabat, Morocco;4. Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France;1. Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt;2. Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo, Egypt;3. Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;4. Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt;5. Hepatology Department, Mustapha Bacha Hospital, University of Algiers, Algeria;6. St. Paul''s Hospital Millennium Medical College, Addis Ababa, Ethiopia;1. Department of Paediatrics, Division of Gastroenterology, Mersin University, Faculty of Medicine, Ankara, Turkey;2. Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey;3. Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, Eski?ehir Osmangazi University, Faculty of Medicine, Eski?ehir, Turkey;4. Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey;1. Institute of Clinical Physiology, National Research Council, Pisa, Italy;2. Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy;1. Chest Department, Assiut University Hospitals, Assiut 71515, Egypt;2. Aswan Faculty of Medicine, Aswan, Egypt;3. Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;4. Faculty of Medicine, Assiut University, Assiut 71515, Egypt;5. Internal Medicine and Surgery (adults), Faculty of Nursing, Assiut University, Egypt;6. Public Health and Community Medicine Department, Assiut Faculty of Medicine, Egypt;7. Undergraduate House Officer, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt;8. Undergraduate House Officer, Faculty of Medicine, Assiut University, Egypt;9. Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Egypt |
| |
| Abstract: | Background and Study AimsIn developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department.Patients and MethodsFrom January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien–Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications.ResultsThe overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios OR], 6.8; 95% confidence intervals CI], 1.55–29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23–11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5–3.89) were independent risk factors for major complications after LR.ConclusionWe recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma. |
| |
| Keywords: | Audit Liver resection Surgical complications Non-Eastern/non-Western Quality improvement |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
