Table 3.
Definitions of postoperative morbidity and mortality
| Event | Criteria |
|---|---|
| Postoperative mortality | Any reason of death within 90 days after major liver resection. |
| Postoperative morbidity | |
| Posthepatectomy liver failure | Increasing INR and bilirubin on or after postoperative day 5 plus deviation from regular clinical management (Grade B definition according to the International Study Group of Liver Surgery [ISGLS]) [14]. |
| Cholangitis | Elevation in temperature more than 38.5°C and Leukocytes ≥10*109/L, thought to have a biliary cause, without concomitant evidence of acute cholecystitis, requiring invasive intervention [13]. |
| Hepaticojejunostomy (biliary) leakage | Drainage of fluid with an increased bilirubin level three times greater than the serum level on or after postoperative day three; or the need for interventions as the result of bile collections or biliary peritonitis; or direct visual evidence of defect at anastomoses (definition according to ISGLS) [15]. |
| Intra-abdominal abscess formation | Intra-abdominal fluid collection with positive cultures identified by ultrasonography or computed tomography, associated with persistent fever and elevations of white blood cells [13]. |
| Wound infection | Requiring intervention; otherwise considered as minor complication [13]. |
| Portal vein thrombosis | Conclusive radiologic evidence of thrombosis [13]. |
| Hemorrhage | A drop in haemoglobin level >3 g/dl post-operatively compared with the post-operative baseline level and/or post-operative transfusion of ≥2 units packed red blood cells for a falling haemoglobin and/or the need for radiological intervention (such as embolization) and/or re-laparotomy to stop bleeding (Grade B/C haemorrhage according to ISGLS) [16]. |
| Emergency re-laparotomy | Any (other) reason following major liver resection [13]. |
| Pneumonia | Pulmonary infection with radiological confirmation and requiring antibiotic treatment [13]. |