Top

Published in:

01-12-2021 | Fatty Liver | Original Scientific Report

Hepatic Steatosis is Associated with an Increased Risk of Postoperative Infections and Perioperative Transfusion Requirements in Patients Undergoing Hepatectomy

Authors: Diego Villagomez, Malay Shah, Francesc Marti, Gabriel Orozco, Daniel Davenport, Meera Gupta, Alexandre Ancheta, Siddharth Desai, Gabriel Vilchez, Joseph Zwischenberger, Roberto Gedaly

Published in: World Journal of Surgery | Issue 12/2021

Abstract

Background

To determine the impact of hepatic steatosis on perioperative outcomes of patients undergoing hepatectomy.

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

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

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.

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):166–172CrossRef

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):462–470CrossRef

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):1026–1031CrossRef

Veteläinen R, van Vliet A, Gouma DJ, van Gulik TM (2007) Steatosis as a risk factor in liver surgery. Ann Surg 245(1):20–30CrossRef

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):923–930CrossRef

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):1050–1057CrossRef

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):2221–2230CrossRef

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):437–449CrossRef

Fielding CM, Angulo P (2014) Hepatic steatosis and steatohepatitis: are they really two distinct entities? Curr Hepatol Rep 13(2):151–158CrossRef

10.

Hobeika C, Ronot M, Beaufrere A, Paradis V, Soubrane O, Cauchy F (2020) Metabolic syndrome and hepatic surgery. J Visc Surg 157(3):231–238CrossRef

11.

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)CrossRef

12.

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):109–116CrossRef

13.

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):1331–1339CrossRef

14.

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):540–550CrossRef

15.

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):1907–1916CrossRef

Title: Hepatic Steatosis is Associated with an Increased Risk of Postoperative Infections and Perioperative Transfusion Requirements in Patients Undergoing Hepatectomy
Authors: Diego Villagomez
Malay Shah
Francesc Marti
Gabriel Orozco
Daniel Davenport
Meera Gupta
Alexandre Ancheta
Siddharth Desai
Gabriel Vilchez
Joseph Zwischenberger
Roberto Gedaly
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keyword: Fatty Liver
Published in: World Journal of Surgery / Issue 12/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-021-06230-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Hepatic Steatosis is Associated with an Increased Risk of Postoperative Infections and Perioperative Transfusion Requirements in Patients Undergoing Hepatectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2021

Predicting Post-Hepatectomy Liver Failure Using Intra-Operative Measurement of Indocyanine Green Clearance in Anatomical Hepatectomy

Transplanting Organs from Donors with HIV or Hepatitis C: The Viral Frontier

Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study

Hemorrhagic Complication in Surgical Resection for Massive Plexiform Neurofibroma in Body Trunk: The Flow-Void Sign as a Predictor and Preoperative Embolization as Prevention

Impact of Lymph Node Metastases Around the Superior Mesenteric Artery on Postoperative Outcomes of Pancreatic Head Cancer

The World Journal of Surgery Announces Two New Assistant Editors for Visual Abstracts and Social Media