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High BMI, major hepatectomy associated with PE after liver resection

Risk factors for pulmonary embolism following liver resection included elevated BMI, normal liver parenchyma and major hepatectomy in a recent study.

Researchers evaluated 410 patients who underwent elective liver resection (LR). All participants had thoracic CT scanning, either with or without a CT pulmonary angiography (CTPA), and were receiving a standardized regimen of thromboprophylaxis. Incidence of pulmonary embolism (PE) was recorded and potential risk factors for the condition were analyzed.

Within 10 days of LR, 24 patients experienced PE, including 16 confirmed via CTPA and eight asymptomatic cases detected via chest multislice CT. These patients more frequently had BMI of 25 kg/m² or greater (75% of patients compared with 46%; P=.006 for difference), had undergone major liver resections (defined as three or more Couinaud’s segments, 79% vs. 45%; P=.003), and had normal or minimally fibrotic liver parenchyma (92% vs. 73%; P=.05). BMI greater than 25 kg/m² (adjusted OR=5.27; 1.89-14.71) and major hepatectomy (OR=3.13; 1.02-9.57) were found independently predictive of PE via multivariate analysis, while normal or minimally fibrotic liver parenchyma approached significance (OR=4.21; 0.95-18.66) (95% CI for all).

Metastatic liver disease was similarly prevalent (25% of PE patients vs. 31% of non-PE; P=.308) and mortality rates after 90 days were similar between groups (4% vs. 3%; P=.77). Patients with PE also were more prone to longer hospital stays (median stay 20 days vs. 11; P=.001). Arterial blood gas analysis indicated significantly different values for pH (7.44 in PE group vs. 7.35 in non-PE; P=.017), oxygen saturation (96% vs. 99%; P<.001) and partial pressure of oxygen (72 mm Hg vs. 178 mm Hg; P<.001), as well as for the ratios of partial pressure to inspired fraction of oxygen (285 vs. 477; P<.001) and of arterial to alveolar oxygen pressure (0.56 vs. 0.81; P<.001).

“Although BMI [greater than] 25 kg/m² and major resection are well-known independent risk factors for PE after surgery, the presence of a normal liver parenchyma is a new factor that needs to be considered in the risk assessment for PE prior to LR,” the researchers wrote. “This suggests that specific thromboembolic mechanisms are involved in liver regeneration and advocates a more aggressive thromboprophylaxis in the high-risk groups.”