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Lack of Decline in Phosphorus Levels After Hepatic Resection Predict Worse Outcomes
Aaron G. Lewis*, Mustafa Raoof, Leanne Goldstein, Michael White, Susanne Warner, Laleh Melstrom, Gagandeep Singh, Yuman Fong
Department of Surgical Oncology, City of Hope, Pasadena, CA
Introduction:
It is known that phosphorus is needed after liver resection for growth of parenchyma, and thus, supplementation has become standard at many high volume centers. We hypothesized that lack of decline in phosphorus levels may indicate suboptimal liver regenerative response and may be associated with worse outcomes.
Methods:
This is a prospective study of an institutional database of all consecutive patients who underwent liver resection between Jan 2009-June 2015. Changes in phosphorus post-resection were correlated to occurrence of a complication. Secondary outcomes were grade III-V complications and 90-day mortality. Univariate analysis was performed using the chi-squared test for categorical variables and t-test for continuous variables. Multivariate Analysis was performed using a step-wise logistic regression.
Results:
A total of 258 patients were included. Median age was 62.5 years (IQR 53-69). A majority was Caucasian (129, 52%) or female (133, 51.6%). Overall and grade III-V complication rates were 39.9% and 5%, respectively. Base line phosphorus levels for patients with (4 IQR 3.4-4.7) and without complications (3.95 IQR 3.5-4.6) were similar (p=0.52). On univariate analysis older age (0.042), higher ASA (p=0.046), ECOG (0.017), lower preoperative albumin (p=0.015), concomitant extrahepatic organ resection (p=0.028), higher operative blood loss (0.0011), need for peri-operative transfusion (p=0.0011), and lack of decline in phosphorus levels from postoperative day 1 to 2 (p=0.019) were significantly associated with occurrence of a complication. On multivariate analysis adjusted for age, operative blood loss, extent of resection, extrahepatic resection, ECOG performance status and phosphorus replacement, a lack of decline in phosphorus levels from postoperative day 1 to 2 was independently associated the occurrence of complications (OR 3.4, 95%CI 1.1-11.3, p=0.042). In addition, a peak phosphorus level greater than 4.5 was associated with complication (p=0.034).
Conclusion:
Lack of decline in phosphorus levels in the early postoperative period is strongly predictive of complication. Furthermore, unnecessary phosphorus replacements could be detrimental in this subset of patients.
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