Early trends in serum phosphate and creatinine levels are associated with mortality following major hepatectomy Journal Article


Authors: Herbert, G. S.; Prussing, K. B.; Simpson, A. L.; D'Angelica, M. I.; Allen, P. J.; DeMatteo, R. P.; Jarnagin, W. R.; Kingham, T. P.
Article Title: Early trends in serum phosphate and creatinine levels are associated with mortality following major hepatectomy
Abstract: Background Mortality after major hepatectomy remains high and is frequently related to post-hepatectomy liver failure (PHLF). Other than pre-existing liver disease and a small future liver remnant, few patient factors or early postoperative indicators identify patients at elevated risk for PHLF and mortality. Methods Data on demographics, comorbidities, operative procedures and postoperative laboratory trends were reviewed for patients submitted to major hepatectomy (at least three Couinaud segments) for malignancy during 1998-2013. These factors were compared among patients who died within 90 days, survivors who met the 50-50 criteria and all remaining survivors. Results A total of 1528 patients underwent major hepatectomy during the study period. Of these, 947 had metastatic colorectal cancer and underwent resection of a median of four segments. Overall, 49 patients (3.2%) died within 90 days of surgery and 48 patients (3.1%) met the 50-50 criteria for PHLF; 30 of these patients survived 90 days. Operative blood loss was higher in patients who died within 90 days compared with survivors (1.0 l versus 0.5 l; P < 0.001). Despite equivalent perioperative resuscitation and urine output, non-survivors had higher creatinine and phosphate levels than survivors on postoperative day (PoD) 1 (1.1 mg/dl versus 0.9 mg/dl and 4.6 mg/dl versus 3.7 mg/dl, respectively; P < 0.001). Conclusions Early trends in creatinine and phosphate (between the day of surgery and PoD 1) identify patients at risk for PHLF and mortality. © 2015 International Hepato-Pancreato-Biliary Association.
Keywords: adult; cancer survival; controlled study; aged; cancer surgery; survival rate; major clinical study; conference paper; creatinine; creatinine blood level; postoperative complication; liver failure; blood analysis; surgical risk; comorbidity; liver resection; surgical mortality; colorectal surgery; perioperative period; trend study; phosphate; resuscitation; urine volume; metastatic colorectal cancer; phosphate blood level; operative blood loss; human; male; female; posthepatectomy liver failure
Journal Title: HPB
Volume: 17
Issue: 12
ISSN: 1365-182X
Publisher: Elsevier Science, Inc.  
Date Published: 2015-12-01
Start Page: 1058
End Page: 1065
Language: English
DOI: 10.1111/hpb.12483
PROVIDER: scopus
PMCID: PMC4644357
PUBMED: 26385577
DOI/URL:
Notes: Export Date: 2 December 2015 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    597 DeMatteo
  2. Peter Allen
    436 Allen
  3. William R Jarnagin
    583 Jarnagin
  4. T Peter Kingham
    281 Kingham
  5. Amber L Simpson
    50 Simpson