BACKGROUND: The definition of postoperative hepatic insufficiency has not yet been standardized, making it difficult to compare innovations concerning hepatic procedures as well as turning the use of postoperative therapeutic interventions a complex task. OBJECTIVES: To evaluate the usefulness and accuracy of diagnosing hepatic insufficiency post-hepatectomy, using prothrombin and seric bilirubin time as predictors of mortality. METHODS: 775 elective hepatectomies were studied. Non-tumoral spleens were abnormal in 43% of cases studied: stenosis > 30% in 107 (14%), fibrosis in 237 (43%) and cirrhosis in 94 (12%). The impact over mortality with remark to prothrombin time being less than 50% and total seric bilirubin being greater than 50 μmol/L (criteria 50-50) in the postoperative days number 1, 3, 5 and 7, was analyzed. RESULTS: Postoperative kinetics regarding prothrombin and seric bilirubin time were distinct. The smallest prothrombin time level occurred in the first postoperative day, whereas seric bilirubin reached its peak in the third day. The tendency of these two biochemical factors to return to preoperative values was sustained in the fifth day. Overall surgical mortality rates were of 3,4% (26 patients), including 21 (81%) cases of abnormal tumor parenchyma and 20 (77%) after major hepatectomy. Mortality rates were higher in patients who presented prothrombin time < 50% or seric bilirubin > 50 μmol/L post surgery. The junction of prothrombin time < 50% and seric bilirubin > 50 μmol/ in the fifth day was a predictive factor for mortality, reaching 59% when this association occurred. CONCLUSION: Beginning from the fifth post surgery day, the association of prothrombin time < 50% and seric bilirubin > 50 μml/L (3 mg/dL) (criteria 50-50) became a practical and accurate predictor of post-hepatectomy mortality. Consequently, this criterion is proposed as a definition of postoperative hepatic insufficiency.
Hepatectomy, mortality; hepatic insufficiency; risk factors; Postoperative complications; liver function tests, mortality
