National High Blood Pressure Education Program.

https://www.journal-of-hepatology.eu/article/S0168-8278(00)80201-9/pdf

Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document

Background Despite improvements in diagnostic and surgical techniques, operative mortality associated with liver resection is still greater than 2% in most of the recent studies. Hypothesis By refining preoperative and postoperative care and surgical skills, liver resection mortality can be decreased to zero. Design Retrospective cohort study to analyze postoperative morbidity and mortality in 1056 consecutive hepatectomies performed at a single medical center during 8 years. Setting Tertiary referral center. Patients A total of 915 patients who underwent 1056 consecutive hepatic resections: 532 for hepatocellular carcinoma, 262 for other primary and secondary liver malignancies, 57 for biliary tract malignancy, 174 for living donor liver transplantation, and 31 for other benign diseases. Main Outcome Measures Operative mortality and morbidity rates. Results No operative mortality occurred. Major complications, as defined by postoperative radiologic or surgical intervention, occurred in 3% of patients with hepatocellular carcinoma, 8% with other liver malignancy, 28% with biliary malignancy, and 5% of living donor liver transplantation donors. Using multiple logistic regression, independent risk factors associated with major complications were operative blood loss of 1000 mL or greater for hepatocellular carcinoma and total bilirubin level of 1.0 mg/dL or greater (≥17 µmol/L) and operative time greater than 6 hours for other liver malignancy. No independent factors associated with major complications were identified for biliary malignancy or for living donor liver transplantation donors among the variables investigated in this study. Conclusions Liver resection can be performed without mortality provided that it is carried out in a high-volume medical center by well-trained hepatobiliary surgeons paying meticulous attention to the balance between the liver functional reserve and the volume of liver to be removed.

https://jamanetwork.com/journals/jamasurgery/articlepdf/395778/soa2233.pdf

One thousand fifty-six hepatectomies without mortality in 8 years.

ESPEN Guidelines on Enteral Nutrition: Liver disease ☆

https://archive-ouverte.unige.ch/unige:112949/ATTACHMENT01

EASL Clinical Practice Guidelines on nutrition in chronic liver disease

Celiotomy in cirrhotic patients is reported to bear a high risk of operative morbidity and mortality. We reviewed 100 consecutive, cirrhotic patients who underwent nonshunt celiotomy. Thirty patients died and major complications occurred in another 30 patients. Hospital mortality rate was 21% in 39 biliary operations, 35% in 26 procedures for peptic ulcer disease, and 55% in nine colectomies . Fifty-two variables were compared between survivors without complication, survivors with complications, and nonsurvivors. A computer-generated, multivariant discriminant analysis yielded an equation predictive of survival. Utilizing coagulation parameters, presence of active infection, and serum albumin, the equation predicted survival with 89% accuracy. In a similar fashion, amount of operative transfusions, absence of postoperative ascites, pulmonary failure, gastrointestinal bleeding, and culture-positive urine predicted survival with 100% accuracy. We conclude that celiotomy in the cirrhotic patient is truly associated with very high morbidity and mortality, and preoperative assessment can predict survival with 89% accuracy.

Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis.

:Operations on the biliary tract in cirrhotic patients are reported to have a higher than normal risk of operative morbidity and mortality. We reviewed 39 cases from two university-based hospitals over a five-year period. Each patient had biliary tract surgery and biopsy-proven cirrhosis. Ei

H M Cryer

Papers

Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis.

Liver cirrhosis and biliary surgery: assessment of risk.