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The impact of post-hepatectomy liver failure on mortality : a population-based study

Gilg, Stefan; Sandström, Per; Rizell, Magnus; Lindell, Gert LU ; Ardnor, Bjarne; Strömberg, Cecilia and Isaksson, Bengt (2018) In Scandinavian Journal of Gastroenterology
Abstract

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... (More)

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.

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author
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
hepatectomy, liver dysfunction, major hepatic resection, population-based, Post-hepatectomy liver failure, post-operative mortality
in
Scandinavian Journal of Gastroenterology
publisher
Taylor & Francis
external identifiers
  • scopus:85055571996
ISSN
0036-5521
DOI
10.1080/00365521.2018.1501604
language
English
LU publication?
no
id
c801d6f6-356a-4e4a-9af8-f9014bf4e009
date added to LUP
2018-12-07 15:19:40
date last changed
2019-02-20 11:39:30
@article{c801d6f6-356a-4e4a-9af8-f9014bf4e009,
  abstract     = {<p>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 &gt;50 µg/L and international normalized ratio &gt;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.</p>},
  author       = {Gilg, Stefan and Sandström, Per and Rizell, Magnus and Lindell, Gert and Ardnor, Bjarne and Strömberg, Cecilia and Isaksson, Bengt},
  issn         = {0036-5521},
  keyword      = {hepatectomy,liver dysfunction,major hepatic resection,population-based,Post-hepatectomy liver failure,post-operative mortality},
  language     = {eng},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {The impact of post-hepatectomy liver failure on mortality : a population-based study},
  url          = {http://dx.doi.org/10.1080/00365521.2018.1501604},
  year         = {2018},
}