Predictive model for postoperative pleural effusion after hepatectomy

• Published in: Annals of gastroenterological surgery Vol. 5; no. 3; pp. 373 - 380
• Main Authors: Nitta, Hidetoshi, Mitsuura, Chisho, Shiraishi, Yuta, Miyata, Tatsunori, Shimizu, Kenji, Harada, Kazuto, Karashima, Ryuichi, Masuda, Toshiro, Matsumoto, Katsutaka, Okino, Tetsuya, Yamashita, Yo‐ichi, baba, Hideo, Takamori, Hiroshi
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.05.2021; John Wiley and Sons Inc; Wiley
• Subjects: Body mass index; Chest tubes; Diaphragm (Anatomy); Diuretics; Dyspnea; Hepatectomy; Hepatitis; Hepatitis C; Hospitals; Laparoscopy; Liver cancer; Multivariate analysis; Original; Patients; Pleural effusion; Postoperative period; Prevention; preventive thoracic drainage; Regression analysis; Risk factors; Ultrasonic imaging; Japan; pleural effusion; hepatectomy; preventive thoracic drainage
• ISSN: 2475-0328; 2475-0328
• DOI: 10.1002/ags3.12417

Aim Severe postoperative pleural effusion (sPOPE) after hepatectomy can lead to respiratory distress and may require thoracic drainage, leading to prolonged hospitalization. Preventive chest tube insertion may be useful for patients at high risk for sPOPE. We aimed to develop a predictive model for sPOPE after hepatectomy and evaluate indications for preventive chest tube insertion using our model. Methods We evaluated all patients who underwent hepatectomy from 2013 to 2020. Risk factors for sPOPE were used to develop a predictive model for sPOPE, which was validated in a cohort that received preventative chest tube placement postoperatively. Results A total of 325 patients were analyzed. Thirty‐one (9.5%) patients had a preventive chest tube placed at the end of their operation. Twenty‐one patients out of the remaining 294 patients developed sPOPE. Multivariate analysis identified resection containing segment 8 [relative risk (RR) 3.24, P = .022], intraoperative bleeding ≥ 500 g (RR 4.02, P = .008), intraoperative diaphragmatic incision (RR 6.96, P = .042) and open hepatectomy (RR 7.51, P = .016) as independently associated with sPOPE. The estimated probability of sPOPE ranged from 0.4% in patients with none of these factors to 73.4% in the presence of all factors. Among the 31 patients who received a preventive chest tube, more patients in the high‐risk group defined by the model had postoperative pleural effusions compared to the low‐risk group (P = .012). Conclusion Our predictive model for sPOPE using four risk factors allows for reliable prediction and may be useful for selection of preventive chest tube in patients undergoing hepatectomy. We established a predictive model for severe posthepatectomy pleural effusion (sPOPE). Our predictive model of sPOPE using four risk factors allows for reliable prediction and may be useful for selection of preventive chest tube in patients undergoing hepatectomy.