Risk factors of hospital mortality after re-laparotomy for post-hepatectomy hemorrhage

World J Surg. 2013 Oct;37(10):2394-401. doi: 10.1007/s00268-013-2147-x.

Abstract

Background: Post-hepatectomy hemorrhage (PHH) requiring re-laparotomy is a life-threatening situation and is associated with a considerably high hospital mortality rate. However, risk factors of hospital mortality in patients with this condition have not yet been investigated.

Methods: The perioperative data of 258 patients with hepatocellular carcinoma who underwent re-laparotomy for PHH from 1997 to 2011 were retrospectively reviewed and evaluated by univariate and multivariate analyses to identify risk factors of hospital mortality.

Result: Hospital death occurred in 43 patients between 16 h and 40 days after re-laparotomy, and the overall mortality rate was 16.7 %. The median time lag between first recognition of active bleeding and re-laparotomy was 6 h (range 0.5-34 h). The mortality of patients undergoing late re-laparotomy (≥6 h) was much higher than those undergoing early re-laparotomy (<6 h) (25 vs 8.6 %; P = 0.001). Multivariate analysis showed early time period (1997-2004) (P = 0.040), liver cirrhosis (P = 0.025), ineffective hemostasis during re-laparotomy due to coagulopathy (P = 0.038), late re-laparotomy (≥6 h) (P = 0.032), postoperative liver failure (P = 0.001), and postoperative acute renal failure requiring hemodialysis (P = 0.024) were independent risk factors of hospital mortality.

Conclusion: Immediate re-laparotomy is a key factor to reduce hospital mortality for patients with active bleeding after partial hepatectomy. More care should be taken in those patients who develop acute liver failure and/or serious acute renal failure after re-laparotomy.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Carcinoma, Hepatocellular / surgery*
  • Female
  • Hepatectomy*
  • Hospital Mortality*
  • Humans
  • Laparotomy / mortality*
  • Liver Neoplasms / surgery*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Hemorrhage / mortality
  • Postoperative Hemorrhage / surgery*
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome