Risk factors for post-operative coagulopathy following hepatic resection and safety of epidural anesthesia: a retrospective cohort single center study

Lapisatepun W; Chotpatiwetchkul A; Junrungsee S; Ko-iam W

Authors

Lapisatepun W Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand
Chotpatiwetchkul A Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand
Junrungsee S Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand
Ko-iam W Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand

Keywords:

hepatic resection, post-operative coagulopathy, risk factors, epidural anesthesia

Abstract

Objectives Hepatic resection is a major abdominal surgery which potentially induced post-operative coagulopathy. Moreover, coagulopathy has become one of the major concerns about the safety of epidural anesthesia.The aim of this study is to identify the incidence and risk factors of coagulopathy after hepatic resection and evaluate the safety of epidural anesthesia.

Methods A retrospective review of elective hepatic resections over a 10-year period was performed. Post-operative coagulopathy was defined as either INR ≥ 1.5 or platelet level < 100,000/µL. A logistic regression analysis was used to identify the independent risk factors, which use to calculate the area under the ROC curve to measure the accuracy of the model.

Results Five hundred and thirty-six patients were included in this study. The incidence of post-operative coagulopathy was 33 percent. The independent factors associated with post-operative coagulopathy included pre-operative thrombocytopenia (OR=10.380 (4.010-26.872)); pre-operative INR > 1.3 (OR = 17.743 (4.751- 66.255)); delta (POD 1 - preoperative) INR > 0.3 (OR = 18.637 (8.949-38.812)); hepatectomy with hilar resection (OR = 3.354 (1.681- 6.692)); estimated blood loss >1,000 mL (OR = 2.086 (1.105-3.936)) and colloid administration > 600 mL (OR = 2.056 (1.052-4.019)). The area under the ROC curve was 0.876.

Conclusion The incidence of coagulopathy after hepatic resection was common. The results showed the possible safety of epidural anesthesia in patients with normal pre-operative coagulation and underwent minor or major hepatectomy without hilar resection. The benefits and risks of epidural anesthesia in hepatic resection should be carefully weighted.

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