Risk factors for pulmonary complications after hepatic resection: role of intraoperative hemodynamic instability and hepatic ischemia

BMC Anesthesiology

Research Article

Yann Loncar¹  Pierre Coriat¹  Louis Lemoine¹  Victoria Lepere¹  Antoine Monsel¹  Daniel Eyraud²  Antoine Vanier³  Jean Christophe Vaillant⁴  Eric Savier⁴ 

[1] Department of Anesthesiology and Reanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospitals Pitié-Salpêtrière Charles-Foix, 43-87 Boulevard de l’Hôpital, 75013, Paris, France;Department of Anesthesiology and Reanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospitals Pitié-Salpêtrière Charles-Foix, 43-87 Boulevard de l’Hôpital, 75013, Paris, France;Department of Digestive, HPB Surgery, and Liver Transplantation University Hospitals Pitié-Salpêtrière Charles-Foix, AP-HP, 43-87 Boulevard de l’Hôpital, 75013, Paris, France;Department of Biostatistics, Sorbonne University, UPMC University, Paris 06, Paris, France;Department of Biostatistics Public Health and Medical Informatics University Hospitals Pitié-Salpêtrière Charles-Foix, AP-HP, 43-87 Boulevard de l’Hôpital, 75013, Paris, France;Department of Digestive, HPB Surgery, and Liver Transplantation University Hospitals Pitié-Salpêtrière Charles-Foix, AP-HP, 43-87 Boulevard de l’Hôpital, 75013, Paris, France;

关键词: Hepatectomy;    Pulmonary complications;    Hepatic ischemia;    Vasopressors;    Gamma-glutamyltransferase (GGT);    Ischemia reperfusion;    Lung injury;   

DOI  :  10.1186/s12871-017-0372-9

 received in 2016-10-24, accepted in 2017-06-05,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPostoperative operative pulmonary complications (PPCs) after hepatic surgery are associated with increased length of hospital stays. Intraoperative blood transfusion, extensive resection and different comorbidities have been identified. Other parameters, like time of hepatic ischemia, have neither been clinically studied, though experimental studies show that hepatic ischemia can provide lung injury. The objective of this study was to determinate the risk factors of postoperative pulmonary complications (PPCs) after hepatic resection within 7 postoperative days.MethodNinety-four patients consecutively who underwent elective hepatectomy between January and December 2013. Demographic data, pathological variables, and preoperative, intraoperative, and postoperative variables had been prospectively collected in a data base. The dependant variables studied were the occurrence of PPCs, defined before analysis of the data.ResultsPPCs occurred in 32 (34%) patients. A multivariate analysis allowed identifying the risk factors for PPCs. On multivariate analysis, preoperative gamma-glutamyltransferase (GGT) elevation OR =5,12 [1,85-15,69] p = 0,002, liver ischemia duration OR = 1,03 [1,01-1,06] p = 0,01 and the intraoperative use of vasopressor OR = 4,40 [1,58-13,36] p = 0,006 were independently associated with PPCs. For every 10 min added in ischemia duration, the OR of the risk of PPCs was estimated to be 1.37 (CI95% = [1.08-1.81], p = 0.01).ConclusionThree risk factors for PPCs have been identified in a population undergoing liver resection: preoperative GGT elevation, ischemia duration and the intraoperative use of vasopressor. PPCs after liver surgery could be related to lung injury induced by liver ischemia reperfusion and not solely by direct infectious process. That could explain why factors influencing directly or indirectly liver ischemia were independently associated with PPCs.

【 授权许可】

CC BY   
© The Author(s). 2017