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BMC Surgery
Published in: BMC Surgery 1/2023

Open Access 01-12-2023 | Disseminated Intravascular Coagulation | Research

Surgery-related disseminated intravascular coagulation predicts postoperative complications

Authors: Yuki Imaoka, Masahiro Ohira, Kouki Imaoka, Tomoaki Bekki, Ryosuke Nakano, Shintaro Kuroda, Hiroyuki Tahara, Kentaro Ide, Tsuyoshi Kobayashi, Yuka Tanaka, Hideki Ohdan

Published in: BMC Surgery | Issue 1/2023

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Abstract

Purpose

The rate of postoperative morbidity, including infectious complications, is still high after major hepatobiliary pancreatic (HBP) surgery. Although surgery-related disseminated intravascular coagulation (DIC) occurs in some cases, its significance has not been elucidated in HBP surgery. This study aimed to evaluate the influence of surgery-related DIC on the complication severity after HBP surgery.

Methods

We analyzed the records of 100 patients with hepatectomy in two or more segments, hepatectomy with biliary tract reconstruction, and pancreaticoduodenectomy. The baseline characteristics and complications were compared between patients with and without surgery-related DIC on postoperative day 1 (POD1) after HBP surgery between 2010 and 2018. Complication severity was assessed using the Comprehensive Complication Index (CCI).

Results

The DIC group (surgery-related DIC on POD1) had predictive factors, such as larger bleeding volume and higher liver enzyme levels. The DIC group exhibited significantly elevated rates of surgical site infection, sepsis, prolonged intensive care unit stay, more frequent blood transfusions, and higher CCI. Furthermore, compared with and without adjustment of DIC, odds ratio (OR) of AST level and operation time for  the risk of high CCI decreased (OR of AST level: 1.25 to 1.19 and OR of operation time: 1.30 to 1.23) and the significant differences had vanished.

Conclusions

Surgery-related DIC on POD1 could be a partial mediator between AST level, operation time and higher CCI. The prevention or proper management of surgery-related DIC on POD1 can be an important target to reduce the severity of postoperative complications.
Literature
1.
Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258(1):129–40.CrossRefPubMed
2.
Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg. 2006;244(2):240–7.CrossRefPubMedPubMedCentral
3.
Malgras B, Duron S, Gaujoux S, Dokmak S, Aussilhou B, Rebours V, Palazzo M, Belghiti J, Sauvanet A. Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors. HPB (Oxford). 2016;18(4):367–74.CrossRefPubMed
4.
Loehrer AP, House MG, Nakeeb A, Kilbane EM, Pitt HA. Cholangiocarcinoma: are North American surgical outcomes optimal? J Am Coll Surg. 2013;216(2):192–200.CrossRefPubMed
5.
Aoki S, Miyata H, Konno H, Gotoh M, Motoi F, Kumamaru H, Wakabayashi G, Kakeji Y, Mori M, Seto Y, et al. Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan. J Hepatobiliary Pancreat Sci. 2017;24:243–51.CrossRefPubMedPubMedCentral
6.
Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009;145(1):24–33.CrossRefPubMed
7.
Wada H, Asakura H, Okamoto K, Iba T, Uchiyama T, Kawasugi K, Koga S, Mayumi T, Koike K, Gando S, et al. Expert consensus for the treatment of disseminated intravascular coagulation in Japan. Thromb Res. 2010;125(1):6–11.CrossRefPubMed
8.
Di Nisio M, Baudo F, Cosmi B, D’Angelo A, De Gasperi A, Malato A, Schiavoni M, Squizzato A. Italian Society for T, Haemostasis: Diagnosis and treatment of disseminated intravascular coagulation: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res. 2012;129(5):e177-184.CrossRefPubMed
9.
Tsuzuki T, Toyama K, Nakayasu K, Iida S, Ueda M, Toizumi A. Disseminated intravascular coagulation after hepatic resection. Surgery. 1990;107(2):172–6.PubMed
10.
Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, O’Beirne J, Fox R, Skowronska A, Palmer D, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33(6):550–8.CrossRefPubMed
11.
Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP, Group S. The STROCSS statement: strengthening the reporting of cohort studies in surgery. Int J Surg. 2017;46:198–202.CrossRefPubMedPubMedCentral
12.
Hayashi H, Morikawa T, Yoshida H, Motoi F, Okada T, Nakagawa K, Mizuma M, Naitoh T, Katayose Y, Unno M. Safety of postoperative thromboprophylaxis after major hepatobiliary-pancreatic surgery in Japanese patients. Surg Today. 2014;44(9):1660–8.CrossRefPubMed
13.
Gando S, Iba T, Eguchi Y, Ohtomo Y, Okamoto K, Koseki K, Mayumi T, Murata A, Ikeda T, Ishikura H, et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med. 2006;34(3):625–31.CrossRefPubMed
14.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
15.
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258(1):1–7.CrossRefPubMed
16.
Nakanishi Y, Tsuchikawa T, Okamura K, Nakamura T, Tamoto E, Noji T, Asano T, Amano T, Shichinohe T, Hirano S. Risk factors for a high comprehensive complication index score after major hepatectomy for biliary cancer: a study of 229 patients at a single institution. HPB (Oxford). 2016;18(9):735–41.CrossRefPubMed
17.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.CrossRefPubMed
18.
Matsumoto M, Wakiyama S, Shiba H, Haruki K, Futagawa Y, Ishida Y, Misawa T, Yanaga K. Usefulness of aspartate aminotransferase to platelet ratio index as a prognostic factor following hepatic resection for hepatocellular carcinoma. Mol Clin Oncol. 2018;9(4):369–76.PubMedPubMedCentral
19.
Cheng J, Zhao P, Liu J, Liu X, Wu X. Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) is a predictor on postoperative outcomes of hepatocellular carcinoma. Medicine (Baltimore). 2016;95(48):e5486.CrossRefPubMed
20.
Ji F, Fu S, Guo Z, Pang H, Chen D, Wang X, Ju W, Wang D, He X, Hua Y, et al. Prognostic significance of preoperative aspartate aminotransferase to neutrophil ratio index in patients with hepatocellular carcinoma after hepatic resection. Oncotarget. 2016;7(44):72276–89.CrossRefPubMedPubMedCentral
21.
Dionigi G, Boni L, Rovera F, Rausei S, Cuffari S, Cantone G, Bacuzzi A, Dionigi R. Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer. World J Gastroenterol: WJG. 2009;15(32):3976–83.CrossRefPubMedPubMedCentral
22.
Shiba H, Ishida Y, Wakiyama S, Iida T, Matsumoto M, Sakamoto T, Ito R, Gocho T, Furukawa K, Fujiwara Y, et al. Negative impact of blood transfusion on recurrence and prognosis of hepatocellular carcinoma after hepatic resection. J Gastrointest Surg. 2009;13(9):1636–42.CrossRefPubMed
23.
Makino Y, Yamanoi A, Kimoto T, El-Assal ON, Kohno H, Nagasue N. The influence of perioperative blood transfusion on intrahepatic recurrence after curative resection of hepatocellular carcinoma. Am J Gastroenterol. 2000;95(5):1294–300.CrossRefPubMed
24.
de Boer MT, Molenaar IQ, Porte RJ. Impact of blood loss on outcome after liver resection. Dig Surg. 2007;24(4):259–64.CrossRefPubMed
25.
Okamura Y, Takeda S, Fujii T, Sugimoto H, Nomoto S, Nakao A. Prognostic significance of postoperative complications after hepatectomy for hepatocellular carcinoma. J Surg Oncol. 2011;104(7):814–21.CrossRefPubMed
26.
Honmyo N, Kobayashi T, Hamaoka M, Kohashi T, Abe T, Oishi K, Tazawa H, Imaoka Y, Akita T, Tanaka J, et al. Comparison of new prognostic systems for patients with resectable hepatocellular carcinoma: albumin-bilirubin grade and albumin-indocyanine green evaluation grade. Hepatol Res. 2019;49(10):1218–26.CrossRefPubMed
27.
Honmyo N, Kobayashi T, Kuroda S, Oshita A, Onoe T, Kohashi T, Fukuda S, Ohmori I, Abe T, Imaoka Y, et al. A novel model for predicting posthepatectomy liver failure based on liver function and degree of liver resection in patients with hepatocellular carcinoma. HPB (Oxford). 2021;23(1):134–43.CrossRefPubMed
28.
29.
Yasuda N, Goto K, Kuribayashi Y, Ohchi Y, Kitano T. Incidence, outcome, and risk factors of cardiovascular surgery-associated disseminated intravascular coagulation: a single-center retrospective study. J Clin Med. 2022;11(13):3633.CrossRefPubMedPubMedCentral
30.
Hashimoto D, Chikamoto A, Miyanari N, Ohara C, Kuramoto M, Horino K, Ohshima H, Baba H. Recombinant soluble thrombomodulin for postoperative disseminated intravascular coagulation. J Surg Res. 2015;197(2):405–11.CrossRefPubMed
31.
Konishi H, Okamoto K, Shoda K, Arita T, Kosuga T, Morimura R, Komatsu S, Murayama Y, Shiozaki A, Kuriu Y, et al. Early thrombomodulin-alpha administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery. World J Gastroenterol: WJG. 2017;23(5):891–8.CrossRefPubMedPubMedCentral
32.
Hashimoto D, Okawa T, Maruyama R, Matsumura F, Shibata Y, Kohrogi H. Anticoagulant therapy for disseminated intravascular coagulation after gastrointestinal surgery. Anticancer Res. 2019;39(1):25–31.CrossRefPubMed
33.
Yamaguchi T, Kitajima Y, Miyauchi Y, Izawa K, Tanaka M, Hirata M, Sadatsuki Y, Ogawa Y. Assessment of bleeding in patients with disseminated intravascular coagulation after receiving surgery and recombinant human soluble thrombomodulin: a cohort study using a database. PLoS ONE. 2018;13(10):e0205146.CrossRefPubMedPubMedCentral
34.
Kuroda S, Kobayashi T, Tashiro H, Onoe T, Oshita A, Abe T, Kohashi T, Oishi K, Ohmori I, Imaoka Y, et al. A multicenter randomized controlled trial comparing administration of antithrombin III after liver resection (HiSCO-05 trial). Surgery. 2021;170:1140–50.CrossRefPubMed
35.
36.
de la Plaza LR, Ramia Angel JM, Bellon JM, Arteaga Peralta V, Garcia Amador C, Lopez Marcano AJ, Medina Velasco AA, Gonzalez Sierra B, Manuel Vazquez A. Clinical validation of the comprehensive complication index as a measure of postoperative morbidity at a surgical department: a prospective study. Ann Surg. 2018;268(5):838–44.CrossRef
37.
Suetani K, Okuse C, Nakahara K, Michikawa Y, Noguchi Y, Suzuki M, Morita R, Sato N, Kato M, Itoh F. Thrombomodulin in the management of acute cholangitis-induced disseminated intravascular coagulation. World J Gastroenterol: WJG. 2015;21(2):533–40.CrossRefPubMedPubMedCentral
38.
Ito T, Nagahara A, Osada T, Kato J, Ueyama H, Saito H, Taniki N, Kanazawa R, Shimizu R, Sai J, et al. Efficacy of recombinant human soluble thrombomodulin in patients with sepsis and disseminated intravascular coagulation in the gastroenterology field. Biomedical reports. 2015;3(4):457–60.CrossRefPubMedPubMedCentral
Metadata
Title
Surgery-related disseminated intravascular coagulation predicts postoperative complications
Authors
Yuki Imaoka
Masahiro Ohira
Kouki Imaoka
Tomoaki Bekki
Ryosuke Nakano
Shintaro Kuroda
Hiroyuki Tahara
Kentaro Ide
Tsuyoshi Kobayashi
Yuka Tanaka
Hideki Ohdan
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2023
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-023-01986-9

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