The Interaction between Diabetes, Body Mass Index, Hepatic Steatosis, and Risk of Liver Resection: Insulin Dependent Diabetes Is the Greatest Risk for Major Complications
Table 2
Analysis of factors associated with major complications following liver resection in 504 patients.
No complication
Major complication
Univariate
Multivariate
value
Odds ratio (95% CI)
value
Median age (range)
64 (21–90)
67 (32–88)
0.015*
1.03 (0.99–1.07)
0.004**
Gender (%)
Male
211 (51.5)
67 (71.3)
0.001*
2.36 (1.34–4.17)
0.028**
Female
199 (48.5)
27 (28.7)
Pathology (%)
Benign
34 (8.3)
6 (6.4)
Primary
83 (20.2)
23 (24.5)
0.622
Secondary
293 (71.5)
65 (69.1)
0.308
Liver-directed chemotherapy (%)
130 (31.7)
33 (35.1)
0.608
Preexisting chronic liver disease (%)
10 (2.4)
1 (1.1)
0.666
Preoperative jaundice (≥50 micromoles/L) (%)
6 (1.5)
3 (3.2)
0.266
Hypoalbuminaemia (<35 g/L) (%)
9 (2.2)
8 (8.5)
0.004*
2.97 (1.01–8.74)
0.047**
Raised preoperative alkaline phosphatase (%)
95 (23.2)
24 (25.5)
0.721
Raised preoperative transaminase (%)
74 (18.0)
21 (22.3)
0.320
Preoperative glomerular filtration rate (%)
≤90 mL/min
274 (66.8)
63 (67.0)
0.892
Median preoperative haemoglobin (g/dL) (range)
13 (9–17)
13 (9–16)
0.025*
0.439
Median preoperative white cell count (/L) (range)
7 (3–17)
7 (3–25)
0.422
Diabetic status (%)
Nondiabetic
370 (90.2)
78 (83.0)
0.014*
0.912
Non-insulin dependent (versus nondiabetic)
32 (7.8)
9 (9.6)
Insulin dependent diabetes (versus non-insulin dependent and nondiabetics)
8 (2.0)
7 (7.4)
3.86 (1.17–12.75)
0.028**
Body mass index (kg/m2) (%)
<25
139 (33.9)
28 (29.8)
0.697
25–30
167 (40.7)
42 (44.7)
>30
99 (24.1)
24 (25.5)
American Association of Anesthesiologists (ASA) grade (%)
1 versus 2
0.198*
1
46 (11.2)
6 (6.4)
0.611
2
266 (64.9)
58 (61.7)
2 versus 3 and 4
3
95 (23.2)
30 (31.9)
0.783
4
2 (0.5)
0
Median P-POSSUM physiologic score (range)
16 (12–32)
18 (12–30)
0.003*
0.764
Operative approach (%)
Laparoscopic
46 (11.2)
4 (4.3)
0.065*
0.812
Open
364 (88.8)
90 (95.7)
Radiofrequency ablation included (%)
18 (4.4)
5 (5.3)
0.698
Wedge resection included (%)
181 (44.1)
22 (23.4)
<0.001*
0.353
Bile-duct reconstruction (%)
34 (8.3)
12 (12.8)
0.246*
0.585
Synchronous bowel procedure (%)
13 (3.2)
10 (10.6)
0.003*
5.99 (2.25–15.96)
<0.001**
Median number of segments resected (range)
3 (1–6)
4 (1–6)
<0.001
1.51 (1.26–1.80)
<0.001**
Repeat operation (%)
31 (7.6)
6 (6.4)
0.861
Intraoperative blood loss (%)
<500 mL
218 (53.2)
29 (30.9)
<0.001
0.463
≥500 mL
188 (45.9)
65 (69.1)
Blood transfusion required (%)
65 (15.9)
41 (43.6)
<0.001
2.48 (1.44–4.30)
0.001**
Steatosis (%)
<33%
308 (75.1)
70 (74.5)
1.000
≥33%
50 (12.2)
11 (11.7)
*Significant at the level of 0.25 for univariate analysis and included in multivariate analysis.
**Significant at the level of 0.05 for multivariate analysis.
