Hepatic Steatosis is Associated with an Increased Risk of Postoperative Infections and Perioperative Transfusion Requirements in Patients Undergoing Hepatectomy.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
accepted:
21
06
2021
pubmed:
22
9
2021
medline:
19
2
2022
entrez:
21
9
2021
Statut:
ppublish
Résumé
To determine the impact of hepatic steatosis on perioperative outcomes of patients undergoing hepatectomy. We analyzed all hepatectomy patients with normal and fatty liver texture, between 2014 and 2018 using NSQIP. Main endpoints included perioperative transfusions (within 72 h) and infectious complications. A total of 8,237 patients underwent hepatectomy during the study period. The overall rate of fatty liver texture (FLG) was 31% (2,557). Operative duration was significantly longer; inflow occlusion was more common (Pringle maneuver), and the need of transfusions was significantly higher in the FLG compared to the normal liver group (NLG) (p = < 0.001). On multivariate analysis, patients in the FLG had increased risk of developing infectious complications (OR 1.22 [95%IC 1.05-1.41]) and transfusion requirements within 72 h after hepatectomy (OR 1.43 [95% CI 1.24-1.63]). Hepatic steatosis is an independent risk factor for the development of infectious complications and increased perioperative transfusion requirements in patients undergoing hepatectomy. Those requiring transfusions within 72 h had also an increased risk of infections after hepatectomy.
Sections du résumé
BACKGROUND
BACKGROUND
To determine the impact of hepatic steatosis on perioperative outcomes of patients undergoing hepatectomy.
METHODS
METHODS
We analyzed all hepatectomy patients with normal and fatty liver texture, between 2014 and 2018 using NSQIP. Main endpoints included perioperative transfusions (within 72 h) and infectious complications.
RESULTS
RESULTS
A total of 8,237 patients underwent hepatectomy during the study period. The overall rate of fatty liver texture (FLG) was 31% (2,557). Operative duration was significantly longer; inflow occlusion was more common (Pringle maneuver), and the need of transfusions was significantly higher in the FLG compared to the normal liver group (NLG) (p = < 0.001). On multivariate analysis, patients in the FLG had increased risk of developing infectious complications (OR 1.22 [95%IC 1.05-1.41]) and transfusion requirements within 72 h after hepatectomy (OR 1.43 [95% CI 1.24-1.63]).
CONCLUSIONS
CONCLUSIONS
Hepatic steatosis is an independent risk factor for the development of infectious complications and increased perioperative transfusion requirements in patients undergoing hepatectomy. Those requiring transfusions within 72 h had also an increased risk of infections after hepatectomy.
Identifiants
pubmed: 34546385
doi: 10.1007/s00268-021-06230-0
pii: 10.1007/s00268-021-06230-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3654-3659Informations de copyright
© 2021. Société Internationale de Chirurgie.
Références
Mullen JT, Moorman DW, Davenport DL (2009) The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250(1):166–172
doi: 10.1097/SLA.0b013e3181ad8935
Gupta M, Dugan A, Chacon E, Davenport DL, Shah MB, Marti F et al (2020) Detailed perioperative risk among patients with extreme obesity undergoing nonbariatric general surgery. Surgery 168(3):462–470
doi: 10.1016/j.surg.2020.03.016
Acosta LF, Garcia CR, Dugan A, Marti F, Davenport D, Gedaly R (2017) Impact of super obesity on perioperative outcomes after hepatectomy: The weight of the risk. Surgery 162(5):1026–1031
doi: 10.1016/j.surg.2017.07.007
Veteläinen R, van Vliet A, Gouma DJ, van Gulik TM (2007) Steatosis as a risk factor in liver surgery. Ann Surg 245(1):20–30
doi: 10.1097/01.sla.0000225113.88433.cf
McCormack L, Petrowsky H, Jochum W, Furrer K, Clavien PA (2007) Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg 245(6):923–930
doi: 10.1097/01.sla.0000251747.80025.b7
d’Assignies G, Fayard C, Leitao H, Alfaiate T, Tubach F, Dokmak S et al (2016) Liver steatosis assessed by preoperative MRI: an independent risk factor for severe complications after major hepatic resection. Surgery 159(4):1050–1057
doi: 10.1016/j.surg.2015.10.008
Reddy SK, Marsh JW, Varley PR, Mock BK, Chopra KB, Geller DA et al (2012) Underlying steatohepatitis, but not simple hepatic steatosis, increases morbidity after liver resection: a case-control study. Hepatology 56(6):2221–2230
doi: 10.1002/hep.25935
Yersiz H, Lee C, Kaldas FM, Hong JC, Rana A, Schnickel GT et al (2013) Assessment of hepatic steatosis by transplant surgeon and expert pathologist: a prospective, double-blind evaluation of 201 donor livers. Liver Transpl 19(4):437–449
doi: 10.1002/lt.23615
Fielding CM, Angulo P (2014) Hepatic steatosis and steatohepatitis: are they really two distinct entities? Curr Hepatol Rep 13(2):151–158
doi: 10.1007/s11901-014-0227-5
Hobeika C, Ronot M, Beaufrere A, Paradis V, Soubrane O, Cauchy F (2020) Metabolic syndrome and hepatic surgery. J Visc Surg 157(3):231–238
doi: 10.1016/j.jviscsurg.2019.11.004
Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 236(4):397–406 (discussion -7)
doi: 10.1097/00000658-200210000-00001
Kurmann A, Wanner B, Martens F, Klasen J, Stickel F, Montani M et al (2014) Hepatic steatosis is associated with surgical-site infection after hepatic and colorectal surgery. Surgery 156(1):109–116
doi: 10.1016/j.surg.2014.02.020
de Meijer VE, Kalish BT, Puder M, Ijzermans JN (2010) Systematic review and meta-analysis of steatosis as a risk factor in major hepatic resection. Br J Surg 97(9):1331–1339
doi: 10.1002/bjs.7194
Nobili C, Marzano E, Oussoultzoglou E, Rosso E, Addeo P, Bachellier P et al (2012) Multivariate analysis of risk factors for pulmonary complications after hepatic resection. Ann Surg 255(3):540–550
doi: 10.1097/SLA.0b013e3182485857
Pessaux P, van den Broek MA, Wu T, Olde Damink SW, Piardi T, Dejong CH et al (2013) Identification and validation of risk factors for postoperative infectious complications following hepatectomy. J Gastrointest Surg 17(11):1907–1916
doi: 10.1007/s11605-013-2226-1