Is central venous pressure still relevant in the contemporary era of liver resection?

• Published in: The Journal of surgical research Vol. 200; no. 1; pp. 139 - 146
• Main Authors: Cheng, Eva See Wah, MD, Hallet, Julie, MD, MSc(c), Hanna, Sherif S., MD, MSc, Law, Calvin H.L., MD, MPH, Coburn, Natalie G., MD, MPH, Tarshis, Jordan, MD, Lin, Yulia, MD, Karanicolas, Paul J., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Blood Loss, Surgical - prevention & control; Blood Loss, Surgical - statistics & numerical data; Blood Pressure Determination; Blood transfusion; Central Venous Pressure; Databases, Factual; Erythrocyte Transfusion - statistics & numerical data; Female; Hepatectomy; Humans; Intraoperative Care - statistics & numerical data; Intraoperative Period; Liver resection; Logistic Models; Male; Middle Aged; Monitoring, Intraoperative - methods; Postoperative Care - statistics & numerical data; Retrospective Studies; Risk Factors; Surgery; Young Adult; Central venous pressure; Liver resection; Anemia; Blood transfusion
• DOI: 10.1016/j.jss.2015.08.005
• ISSN: 0022-4804

Abstract Background Perioperative red blood cell transfusion (RBCT) remains common after liver resection and carries risk of increased morbidity and worse oncologic outcomes. We sought to assess the factors associated with perioperative RBCT after hepatectomy with a focus on intraoperative hemodynamics. Methods We performed a retrospective review of our prospective hepatectomy database, supplemented by a review of anesthetic records of all patients undergoing hepatectomy with hemodynamic monitoring (arterial and central venous pressures [CVP]) from 2003–2012. Primary outcome was perioperative RBCT (during and within 30 d after surgery). After descriptive and univariate comparisons, multivariate analysis was conducted to identify factors associated with RBCT. Results Of 851 hepatectomies, 530 had complete hemodynamic data and 30.2% (161 of 530) received RBCT. Among transfused patients, female gender ( P  = 0.01), preoperative anemia ( P  < 0.001), and major liver resection ( P  = 0.02) were more common. Mean estimated blood loss was 1.1 L higher (2.0 versus 0.9 L; P  < 0.001) and operating time was 1.1 h longer (5.8 versus 4.7 h; P  < 0.001) in transfused patients. Trends in intraoperative CVP differed significantly based on transfusion status ( P  = 0.007). Independent factors associated with RBCT included female gender (odds ratio [OR], 2.27; P  = 0.01), preoperative anemia (OR, 2.38; P  = 0.03), longer operative time (OR, 1.19 per hour; P  = 0.03), and higher intraoperative CVP at 1 h during surgery (OR, 1.10 per mm Hg; P  = 0.005). Conclusions Likelihood of RBCT is independently associated with female gender, preoperative anemia, longer operative time, and higher intraoperative CVP. Focus on management of preoperative anemia, operative efficiency, and low intraoperative CVP is needed to minimize the need for RBCTs.