Post hepatectomy hypophosphatemia and its association with initial liver insufficiency and morbidity

Abstract

Background: Hypophosphatemia after liver resection is a frequent issue, only a small subset of patient requires correction. This group of patients associated with morbidity was evaluated.Methods: Liver resections were retrospectively analysed between Jan 2015 and March 2018. We evaluated the association of hypophosphatemia (defined as serum phosphate <2mg/dl) and the occurrence of initial liver insufficiency (ILI) [ Elevation of total bilirubin above 2mg/dl above the preoperative values and INR more than 1.7]. Any association of hypophosphatemia with post-operative major morbidity (Clavien Dind0 grade 3 and 4 complications) was also studied.Results: A total of 86 patients were analysed during the study period, 28 patients were excluded as per the exclusion criteria and 58 patients were included in the study. Majority of the patients in our study populations were above 60yrs of age with male preponderance. Hepatocellular carcinoma was the frequent indication for surgery. Significant hypophosphatemia was seen in 15 patients reaching nadir values on Post-operative day 3. Clavien Dindo Grade- 3,4 complications was seen in 7 patients and 8 patients had Initial liver insufficiency.Conclusions: This study tried to evaluate only the subset of patients who had significant hypophosphatemia who required replacement with initial liver insufficiency and morbidity. We have found association of hypophosphatemia with initial liver insufficiency and morbidity. Hence, authors advocate early identification and correction to avoid possible complications.