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

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.

“The Prognostic Role of Aspartate Transaminase to Platelet Ratio Index (APRI) on Outcomes Following Non-emergent Minor Hepatectomy”

“…14 In another analysis of 5337 minor hepatectomies between 2014 and 2018, Villagomez et al found transfusion to be an independent predictor of postoperative infectious complications (P < .05). 3 Previous systematic reviews and single-institution retrospective analyses have found transfusion to be predictive of overall morbidity, major complications, and greater length of stay after hepatectomy. [15][16][17][18] In addition to short-term mortality risk, there is evidence that transfusions may portend poor 90-day survival as well as long-term disease free survival (DFS) and overall survival (OS) after hepatectomy.…”

“…14 In another analysis of 5337 minor hepatectomies between 2014 and 2018, Villagomez et al found transfusion to be an independent predictor of postoperative infectious complications ( P < .05). 3 Previous systematic reviews and single-institution retrospective analyses have found transfusion to be predictive of overall morbidity, major complications, and greater length of stay after hepatectomy. 15-18…”

“…Degrees of fatty liver disease (FLD), such as fibrosis and cirrhosis, are associated with an increased risk of perioperative surgical complications and transfusions after hepatectomy. [1][2][3][4] In a matched cohort analysis of patients who underwent major hepatectomy, McCormack and colleagues found a 14% mortality rate in the moderate/severe hepatic steatosis cohort compared to 6.8% in the mild hepatic steatosis cohort and 1.7% in the normal liver cohort. 4 Furthermore, a higher rate of intraoperative blood transfusions was found among patients with nonalcohol fatty liver disease (NAFLD) compared to those without NAFLD (37.8% vs 28.0%, P = .0208) in a retrospective review of patients undergoing hepatectomy for hepatocellular carcinoma (HCC).…”