Incidence, patterns and management of complications (90-day-analysis) after liver surgery : a single center experience with 3177 consecutive hepatic resections

Abstract

Purpose Despite recent advances in surgical techniques and perioperative management, liver surgery is still associated with perioperative morbidity and mortality. This study aims to investigate the spectrum, risk factors and management of postoperative complications.

Methods All patients who underwent liver resection between 01/2008 until 12/2023 were identified from a prospective institutional database. The data was analyzed regarding postoperative morbidity and mortality rates.

Results We identified 3 177 liver resections including 1 345 (42.3%) major hepatectomies (≥ 3 segments). Complications occurred in 1 530 (48.2%). Of these, 460 (14.5%) were grade IIIa, 133 (4.2%) grade IIIb, 118 (3.7%) grade IVa, 13 grade IVb and 111 (3.5%) grade V. A total of 1 158 reinterventions were performed including 256 reoperations, 61 s operative revisions, 109 endoscopic procedures and 732 percutaneous interventions. In multivariate analysis age (p < 0.001), need for hepaticojejunostomy (p < 0.001), duration of operation (p = 0.001), and intraoperative blood transfusion (p < 0.001) were independent risk factors for mortality. Operative revision was associated with an increased mortality rate (26.6% vs. 1.5%, p < 0.001).

Conclusion The need for operative revision marked a subgroup with particularly poor outcome, emphasizing the importance of early detection, minimally invasive complication management whenever feasible, and careful risk stratification in complex liver surgery. Operative revision should be reserved for cases that cannot be managed successfully by intervention or when inevitable.