Virani et al identified risk factors for morbidity and mortality following hepatic resection. These can help to identify a patient who may benefit from more aggressive management or an alternative treatment strategy. The authors are from Harvard Medical School, Massachusetts General Hospital, University of Colorado, VA Boston Healthcare System and Brigham and Women's Hospital.
Patient selection: hepatic resection of primary or metastastic liver tumor
Risk factors for morbidity:
(1) serum hypoalbuminemia
(2) serum SGOT (AST) > 40 IU/L
(3) history of previous cardiac operation
(4) operative work relative value unit (RVU)
(5) severe COPD
The mortality rate was 0.7% if there were no complications but 9% if any complications occurred.
Risk factors for mortality within 30 days of the operation:
(1) male gender
(2) ASA class 3 to 5
(3) presence of ascites
(4) dyspnea
(5) severe COPD
Operative factors associated with 30-day mortality:
(1) longer operative time
(2) higher operative RVU
(3) higher number of RBC units transfused
(4) contaminated or infected wound class
Limitations:
• The method and reference range for the SGOT (AST) was not given. A value > 40 IU/L is presumed to be elevated.
