Perioperative medicine & outcomes
Failure of preoperative data to accurately predict which patients undergoing major hepatic surgery will develop postoperative coagulation disturbances: a single-hospital retrospective cohort study
Authors' conclusion
Coagulation disturbances occur commonly in the context of hepatic surgery. Preoperative data commonly used to qualify a patient to receive epidural analgesia are insufficient to predict which patients are likely to develop postoperative coagulation disturbance. Regardless of the predictive modeling or criterion, the postoperative risk of coagulopathic disturbance will exceed 5% by 72 hr postoperatively.
Study context
- Population
- Patients undergoing liver resection at the University of Iowa, 2011–2023, eligible for epidural analgesia647 analysed
- Participants
- 684 patients
- Outcome
- Postoperative coagulation disturbance (INR > 1.5, PTT > 40 sec, or platelet count < 100,000 × 106·L-1)
- Follow-up
- Within 72 hr
Methodological detailssingle-hospital, 37 excluded for LOS ≤ 72 hr or preoperative coagulation disturbance
- Single-hospital
- 37 excluded for LOS ≤ 72 hr or preoperative coagulation disturbance
Main finding
As reported in the abstract
Incidence of postoperative coagulation disturbances
25%
95% CI 22 to 28
Thrombocytopenia (of all patients)
20%
Noted on POD 1
11%
Noted on POD 2
22%
Observational data: associations, not effects.
Further findings
Volume of liver resected as predictor
- Greater volume resected with postoperative coagulation disturbance
- P < 0.001
- AUC
- 0.61
Other preoperative predictors (sex, ASA, BMI, weight, age, adjuvant chemotherapy, estimated operative duration, year)
- No predictive value (all standardized differences < 0.24)
Classification tree modeling
- Single node (no useful preoperative prediction)
Stepwise backward logistic regression: predicted probability of coagulation disturbance
- Patients with predicted probability < 10%
- 2 (0.3%)
- Patients with predicted probability < 5%
- 0
Thoracic epidural received
- Received thoracic epidural
- 512 (79%)
Original publication
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