Impact of intraoperative blood loss on postoperative morbidity after liver resection for primary and secondary liver cancer

Background: We sought to determine the association between intraoperative blood loss (IBL) and postoperative morbidity among patients undergoing surgery for liver cancer. Methods: Patients undergoing surgery for primary and secondary liver cancer were identified from a multi-institutional database. Adjusted blood loss (aBL) was calculated by normalizing IBL to body weight; the comprehensive complication index (CCI) was used to evaluate postoperative complications. Results: A total of 2491 patients were included. Mean CCI was 10.6 (±5.2) for patients with aBL <10 mL/kg versus 15.2 (±7.2) for individuals with aBL ≥10 mL/kg (p < 0.001). On cubic spline regression, a nonlinear correlation between aBL and CCI was observed. CCI increased exponentially for aBL ranging from 5 to 10 mL/kg, then reached a plateau between an aBL of 10–30 mL/kg before dramatically increasing for aBL >30 mL/kg. Recursive partitioning technique demonstrated that an aBL threshold of 8.5 mL/kg best distinguished CCI (p < 0.001). Additionally, patients with an aBL ≥8.5 mL/kg had worse recurrence-free and overall survival versus patients with an aBL <8.5 mL/kg. Conclusion: A nonlinear incremental correlation between aBL and CCI was identified among patients undergoing surgery for liver cancer. Maintaining an aBL <8.5 mL/kg during LR may help reduce postoperative morbidity.