Thirty-day mortality leads to underestimation of postoperative death after liver resection: A novel method to define the acute postoperative period

Schiergens, Tobias S.; Dörsch, M; Mittermeier, Laura; Brand, Katharina; Küchenhoff, Helmut; Lee, Serene M. L.; Feng, Hao; Jauch, Karl‐Walter; Werner, Jens; Thasler, Wolfgang E.

doi:10.1016/j.surg.2015.07.019

Cited by 30 publications

(25 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This enabled survival analysis independently of biasing mortality effects caused by age and comorbidities as these have been identified as risk factors for increased perioperative mortality in several studies (6,7,10,31). This was confirmed for the present population in a recent analysis, too (32). This study was approved by the Ethics Committee of the Faculty of Medicine, Ludwig-Maximilians-University.…”

Section: Design and Study Populationsupporting

confidence: 85%

Time‐dependent impact of age and comorbidities on long‐term overall survival after liver resection

Schiergens

Lindenthaler

Thomas

et al. 2016

Liver International

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Design and Study Populationsupporting

confidence: 85%

Time‐dependent impact of age and comorbidities on long‐term overall survival after liver resection

Schiergens

Lindenthaler

Thomas

et al. 2016

Liver International

Self Cite

View full text Add to dashboard Cite

show abstract

“…18 It is obvious that limiting the observation to the hospital stay is insufficient due to major center variations, and a consensus seems to arise proposing a minimum of 3 months. [19][20][21][22][23][24][25][26][27] In the current study, a number of events occurred between the time of discharge and 3 months postoperatively, but very few afterward corroborating the standardized use of benchmarking at 3 months.…”

Section: Discussionsupporting

confidence: 65%

“…34 In addition, there was a lack of clearly defined standard outcome measures, as complications were only assessed as ''peri-and postoperative'' events, not focusing on 3 and 6 months morbidity, as now widely proposed. [19][20][21][22][23][24][25][26][27] Moreover, A2ALL study group used an earlier version of complication grading, and not the most recent and widely accepted version of the Clavien-Dindo classification. 3 Of course, interpretation of any outcome data must be riskadjusted accounting for cases that mix across different populations (eg, different centers) and time (eg, within a center).…”

Section: Discussionmentioning

confidence: 99%

Defining Benchmarks for Major Liver Surgery

Rössler¹,

et al. 2016

View full text Add to dashboard Cite

“…Despite substantial improvements in liver surgery, postoperative LD, morbidity and mortality still represent a major clinical concern[6, 7, 25]. In this study, we were able to demonstrate that low levels of ATIII-activity as early as on the first day after surgery could predict postoperative outcome in a retrospective evaluation cohort of 228 patients suffering from mCRC.…”

Section: Discussionmentioning

confidence: 64%

Early prediction of postoperative liver dysfunction and clinical outcome using antithrombin III-activity

et al. 2017

View full text Add to dashboard Cite

Background and aimsAntithrombin III (ATIII) has been reported to be associated with liver pathologies and was shown to predict outcome in patients undergoing liver resection for hepatocellular carcinoma. We now aimed to assess whether perioperative ATIII-activity could predict postoperative outcome in patients without underlying liver disease, as well as in a routine clinical setting of patients undergoing hepatic resection.MethodsATIII-activity was evaluated preoperatively and on the first (POD1) and fifth day after liver resection in a retrospective evaluation cohort of 228 colorectal cancer patients with liver metastasis (mCRC). We further aimed to prospectively validate our results in a set of 177 consecutive patients undergoing hepatic resection.ResultsPatients developing postoperative liver dysfunction (LD) had a more pronounced postoperative decrease in ATIII-activity (P<0.001). ATIII-activity on POD1 significantly predicted postoperative LD (P<0.001, AUC = 84.4%) and remained independent upon multivariable analysis. A cut-off value of 61.5% ATIII-activity was determined using ROC analysis. This cut-off was vital to identify high-risk patients for postoperative LD, morbidity, severe morbidity and mortality (P<0.001, respectively) with a highly accurate negative predictive value of 97%, which could be confirmed for LD (P<0.001) and mortality (P = 0.014) in our independent validation cohort. Further, mCRC patients below our cut-off suffered from a significantly decreased overall survival (OS) at 1 and 3 years after surgery (P = 0.011, P = 0.025).ConclusionsThe routine laboratory parameter ATIII-activity on POD1 independently predicted postoperative LD and was associated with clinical outcome. Patients with a postoperative ATIII-activity <61.5% might benefit from close monitoring and timely initiation of supportive therapy.Trial registrationClinicalTrials.gov NCT01700231

show abstract

Thirty-day mortality leads to underestimation of postoperative death after liver resection: A novel method to define the acute postoperative period

Cited by 30 publications

References 39 publications

Time‐dependent impact of age and comorbidities on long‐term overall survival after liver resection

Time‐dependent impact of age and comorbidities on long‐term overall survival after liver resection

Defining Benchmarks for Major Liver Surgery

Early prediction of postoperative liver dysfunction and clinical outcome using antithrombin III-activity

Contact Info

Product

Resources

About