Assessment of bloodproducts use as predictor of p

Authors: Hiroaki Shiba Yuji Ishii Yuichi Ishida Shigeki Wakiyama Taro Sakamoto Ryusuke Ito Takeshi Gocho Tadashi Uwagawa Shoichi Hirohara Yoshiaki Kita Takeyuki Misawa Katsuhiko Yanaga

Publish Date: 2008/12/16

Volume: 16, Issue: 1, Pages: 69-74

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Abstract

In perioperative management after hepatectomy some patients require fresh frozen plasma FFP to treat coagulopathy associated with blood loss However several studies have suggested a correlation between blood products and pulmonary complications or surgicalsite infection SSIThe subjects were 99 patients who underwent hepatectomy for hepatocellular carcinoma without plasma exchange for postoperative liver failure in the Department of Surgery Jikei University Hospital between January 2000 and December 2006 We investigated the association of 16 factors including age gender preoperative ICGR15 type of resection concomitant resection of other digestive organs duration of operation blood loss hepatitis virus status postoperative minimum platelet count maximum serum total bilirubin max TBil minimum serum albumin or minimum prothrombin time and the dose of redbloodcell concentration RC FFP platelet concentration or albumin given in relation to postoperative pulmonary complications and SSIIn univariate analysis pulmonary complications were correlated with gender P = 0012 max TBil P = 0043 dose of RC given P = 0007 dose of FFP given P  0001 and dose of albumin given P  0001 In multivariate analysis pulmonary complications were correlated with FFP given P = 0031 and albumin given P = 0020 while the incidence of SSI was not correlated with any factorsIn Japan blood products such as fresh frozen plasma FFP and albumin have been administered rather liberally after hepatectomy for hepatocellular carcinoma HCC to maintain plasma osmotic pressure and coagulation factor levels 1 2 because appropriate guidelines for bloodproducts transfusion had not yet been established 3 4 5 6 Then in 1999 the guidelines for administration of blood preparations were released from the Japanese Ministry of Health and Welfare 7 Indications of FFP use have been limited to reduce consumption of FFPSeveral studies have suggested the involvement of FFP in pulmonary complications and surgicalsite infections SSI after surgery 8 9 In recent years the use of FFP has partially been replaced by albumin preparations However there are no standardized guidelines for the use of albumin preparations 10 11 12 13 On the other hand in perioperative management of hepatectomy for HCC coagulopathy and albumin composition dysfunction by concomitant chronic liver disease are not unusual and administration of blood components may be essential Therefore the usefulness and risk of bloodproducts use in perioperative management of hepatectomy for HCC needs to be evaluated In this study we retrospectively investigated factors pertinent to pulmonary complications and SSI after hepatectomy for HCC to clarify risk factors for such complications with special reference to perioperative bloodproducts useBetween January 2000 and December 2006 101 patients underwent hepatectomy for HCC in the Department of Surgery Jikei University Hospital Of these two patients who required plasma exchange for postoperative liver failure were excluded and the remaining 99 patients were studied Generally the extent of hepatectomy was determined based on ICGR15 before surgery and hepatic reserve as described by Makuuchi et al 14 The use of blood products was determined by attending surgeons and the dose of blood products given was judged based on intraoperative blood loss and postoperative hemoglobin level platelet count serum albumin level and prothrombin time PTWe investigated the association of pulmonary complications and SSI with the following 16 factors age gender preoperative ICGR15 type of resection concomitant resection of other digestive organs duration of operation blood loss hepatitis virus status postoperative data of minimum platelet count min Plt maximum serum total bilirubin max TBil minimum serum albumin min Alb or minimum prothrombin time min PT and the dose of redbloodcell concentration RC FFP platelet concentration PC or albumin given Pulmonary complications were defined as postoperative pneumonia postoperative respiratory failure with pyrexia dyspnea and a pulmonary infiltrate on chest Xrays or pleural effusion that required thoracentesis SSI was defined as surgical wound infection with purulent discharge and bacterial isolation or abdominal abscess with pyrexia The type of resection was classified into two types anatomical hepatectomy extended lobectomy lobectomy segmentectomy or subsegmentectomy and limited partial resection

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