Predictors of Liver Failure in Non-Cirrhotic Patients Undergoing Hepatectomy.

BACKGROUND: Post-hepatectomy liver failure (PHLF) is associated with high mortality following liver resection. There have been limited studies evaluating predictors of PHLF and clinically significant PHLF in non-cirrhotic patients. METHODS: This was a retrospective cohort study using the National Surgical Quality Improvement Program database (NSQIP) to evaluate 8,093 non-cirrhotic patients undergoing hepatectomy from 2014 to 2018. Primary endpoints were PHLF and clinically significant PHLF (PHLF grade B or C). RESULTS: Among all patients, 4.74% (n = 383) developed PHLF and 2.5% clinically significant PHLF (n = 203). The overall 30-day mortality was 1.35% (n = 109), 11.5% (n = 44) in patients with PHLF, and 19.2% in those with clinically significant PHLF. Factors associated with PHLF were: metastatic liver disease (OR = 1.84, CI = 1.14-2.98), trisectionectomy (OR = 3.71, CI = 2.59-5.32), right total lobectomy (OR = 4.17, CI = 3.06-5.68), transfusions (OR = 1.99, CI = 1.52-2.62), organ/space SSI (OR = 2.84, CI = 2.02-3.98), post-operative pneumonia (OR = 2.43, CI = 1.57-3.76), sepsis (OR = 2.27, CI = 1.47-3.51), and septic shock (OR = 5.67, CI = 3.43-9.36). Patients who developed PHLF or clinically significant PHLF had 2-threefold increased risk of perioperative mortality. Post-hepatectomy renal failure (OR = 8.47, CI = 3.96-18.1), older age (OR = 1.04, CI = 1.014-1.063), male sex (OR = 1.83, CI = 1.07-3.14), sepsis (OR = 2.96, CI = 1.22-7.2), and septic shock (OR = 3.92, CI = 1.61-9.58) were independently associated with 30-mortality in patients with clinically significant PHLF. CONCLUSION: PHLF in non-cirrhotic patients increased the risk of perioperative mortality and is associated with the extent of hepatectomy and infectious complications. Careful evaluation of the liver remnant, antibiotic prophylaxis, nutritional assessment, and timely management of post-operative infections could decrease major morbidity and mortality following hepatectomy.

Perioperative Challenges in Patients Transplanted with Livers from Extreme Obese Donors.

The combination of rising rates of obesity and the shortage of deceased donor livers have forced the consideration of marginal liver donors in terms of body mass index (BMI) for liver transplantation (LT). To date, there are still conflicting data on the impact of donor obesity on post-LT outcomes. We analyzed all patients undergoing LT alone in the United States (US) from October 2005 through December 2019 using the United Network of Organ Sharing (UNOS) data set. We categorized donor BMI >40 kg/m2 as extremely obese (EO). Primary endpoints included 30-day perioperative mortality and early graft loss (EGL) within 7 days. A subgroup analysis was performed for the EO donor group to assess how macrovesicular steatosis (MaS) >30% affects 30-day mortality and EGL within 7 days. A total of 72,616 patients underwent LT during the study period. The 30-day perioperative mortality was significantly higher in the EO donor group (P = 0.02). On multivariate analysis, recipients undergoing LT with EO donors had a 38% higher 30-day mortality risk (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.21-1.69) and 53% increased risk of EGL (OR, 1.53; 95% CI, 1.22-1.90). MaS >30% was independently associated with a 2-fold increased risk of 30-day mortality (P = 0.003) and 3.5-fold increased risk of EGL within 7 days (P < 0.001). The impact of MaS >30% in EGL was 2-fold for all patients transplanted during the study period compared with 3.5-fold in the EO donor group. There is an increased risk of EGL and 30-day perioperative mortality in recipients transplanted with EO donors. Future studies are warranted in morbid and super obese donors to assess the possible effect of obesity-related proinflammatory factors in EGL.

Hepatic Steatosis is Associated with an Increased Risk of Postoperative Infections and Perioperative Transfusion Requirements in Patients Undergoing Hepatectomy.

BACKGROUND: To determine the impact of hepatic steatosis on perioperative outcomes of patients undergoing hepatectomy. METHODS: We analyzed all hepatectomy patients with normal and fatty liver texture, between 2014 and 2018 using NSQIP. Main endpoints included perioperative transfusions (within 72 h) and infectious complications. RESULTS: A total of 8,237 patients underwent hepatectomy during the study period. The overall rate of fatty liver texture (FLG) was 31% (2,557). Operative duration was significantly longer; inflow occlusion was more common (Pringle maneuver), and the need of transfusions was significantly higher in the FLG compared to the normal liver group (NLG) (p = < 0.001). On multivariate analysis, patients in the FLG had increased risk of developing infectious complications (OR 1.22 [95%IC 1.05-1.41]) and transfusion requirements within 72 h after hepatectomy (OR 1.43 [95% CI 1.24-1.63]). CONCLUSIONS: Hepatic steatosis is an independent risk factor for the development of infectious complications and increased perioperative transfusion requirements in patients undergoing hepatectomy. Those requiring transfusions within 72 h had also an increased risk of infections after hepatectomy.

Adolescentes mujeres y jóvenes adultas frente a los temas de embarazo y aborto: ¿Percepciones diferentes según la edad? Estudio realizado en Quito, Ecuador (2017) / Adolescent women and young adults facing the issues of pregnancy and abortion: Different perceptions according to age? Study conducted in Quito, Ecuador (2017) / Adolescentes e mulheres jovens que enfrentam as questões da gravidez e do aborto: Percepções diferentes de acordo com a idade? Estudo realizado em Quito, Equador (2017)

Resumen: El objetivo del estudio fue analizar las percepciones acerca del embarazo y aborto en dos grupos de mujeres. Se encuestó a 100 adolescentes y a 100 jóvenes adultas de la ciudad de Quito; además, con una entrevista semiestructurada, se indagó sobre sus vivencias. Se encontraron diferencias entre los grupos sobre las percepciones de embarazo, entre ellas: requisitos para ser madres, responsabilidades propias y de los abuelos, emociones, apoyo social y mejor opción frente al embarazo. En relación al aborto, existen diferencias en cuanto a su percepción general y de apoyo social. Se presentan resultados sobre sentimientos en el momento del aborto y de su estado actual, sobre la decisión, reacción de la pareja, entre otras. Los resultados indican la importancia de reenfocar la educación sexual, tomando en cuenta las etapas de desarrollo, basados en información pertinente.

Abstract: The objective of the study was to analyze the perceptions about pregnancy and abortion in two groups of women. One hundred adolescents and 100 young adults from Quito were surveyed; in addition, using a semi-structured interview, information about their experiences was collected. Differences on the perceptions of pregnancy were found between the two groups, subjects such as the requirements to be mothers, their own and grandparents' responsibilities, emotions, social support, and choices in relation to pregnancy. Regarding abortion, there were differences concerning its general perception and social support. Results about feelings at the time of the abortion and in its current state, about the decision, the couple's reaction, among others, are presented. The results highlight the importance of refocusing sexual education, considering the stages of development of women, and relevant scientific information.

Resumo: O objetivo do estudo foi analisar as percepções sobre gravidez e aborto em dois grupos de mulheres. Foram pesquisadas ​​100 adolescentes e 100 adultas jovens da cidade de Quito; também, com uma entrevista semiestruturada, eles foram questionados sobre suas experiências. Houve diferenças entre os grupos quanto às percepções da gravidez, dentre elas: requisitos para ser mãe, responsabilidades próprias e dos avós, emoções, apoio social e melhor opção contra a gravidez. Em relação ao aborto, existem diferenças em termos de percepção geral e apoio social. São apresentados resultados sobre sentimentos no momento do aborto e seu estado atual, sobre a decisão, a reação do casal, entre outros. Os resultados indicam a importância de reorientar a educação sexual, levando em conta os estágios de desenvolvimento, baseados em informações pertinente.