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Intraoperative and Immediate Postoperative Comparison

Bhargavi Gali, MD; James Y. Findlay, MBChB; David J. Plevak, MD; Charles B. Rosen, MD; Ross Dierkhising, MS; David M. Nagorney, MD

Arch Surg. 2007;142:467-472.

Hypothesis  Perioperative events of patients undergoing living donor (LD) right hepatectomy are similar to those of patients undergoing right hepatectomy for disease (DZ).

Design  Institutional review board–approved retrospective case-control study.

Setting  Eight hundred–bed tertiary care referral center.

Patients and Methods  We matched 40 patients who had LD with 40 patients who had DZ. Perioperative events (anesthesia, surgical events, transfusion, hemodynamic events, complications, and length of hospital stay) were compared using the signed rank test and exact McNemar test where appropriate.

Main Outcome Measures  Intraoperative time, transfusion requirements, postoperative complications, and hospital length of stay.

Results  There was a significant difference in surgical time between the LD and DZ groups (median, 4.1 vs 3.3 hours; P = .001). There was also a significant difference in anesthesia time between the LD and DZ groups (median, 5.6 vs 4.2 hours; P<.001). The level of autologous transfusion was higher in the LD group (median, 1.3 vs 0 U in the DZ group; P<.001), and that of packed red blood cell transfusion was lower in the LD group (mean, 0 vs 0.5 U; P = .008). There was no other significant intraoperative difference. Postoperative hemoglobin levels were significantly higher in the LD group (median, 12.6 vs 11.8 g/dL; P = .03). Comparison of the number of complications in the immediate postoperative period revealed no other significant differences.

Conclusions  The LD procedure took longer to perform because of the time required for hilar dissection. The difference in intraoperative transfusions is attributable to use of cell salvage and retransfusion of salvaged blood for all donors; this was not routine for DZ procedures. Perioperative outcomes were similar in all other respects. The LD procedure has similar outcomes to those of the DZ procedure.

Author Affiliations: Departments of Anesthesiology (Drs Gali, Findlay, and Plevak), Surgery (Drs Rosen and Nagorney), and Statistics (Mr Dierkhising), Mayo Clinic College of Medicine, Rochester, Minn.

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