Risk Factors of Hospital Mortality after Re-laparotomy for Post-hepatectomy Hemorrhage
Tian Yang
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorLi Li
Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorQian Zhong
Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorWan Yee Lau
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China
Search for more papers by this authorHan Zhang
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorXing Huang
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorWei-Feng Yu
Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorCorresponding Author
Feng Shen
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorCorresponding Author
Jie-Wei Li
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorMeng-Chao Wu
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorTian Yang
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorLi Li
Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorQian Zhong
Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorWan Yee Lau
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China
Search for more papers by this authorHan Zhang
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorXing Huang
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorWei-Feng Yu
Intensive Care Unit, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorCorresponding Author
Feng Shen
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorCorresponding Author
Jie-Wei Li
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorMeng-Chao Wu
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, 200438 Shanghai, People’s Republic of China
Search for more papers by this authorTian Yang and Li Li contributed equally to this study.
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.
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