K. Culbreath1, A. Garcia1, I. Leeds1, T. Crawford1, E. Boss2, D. Rhee1 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Otolaryngology,Baltimore, MD, USA
Introduction: Children with primary malignant tumors of the liver often present with an incidental abdominal mass and anemia, with failure to thrive in more advanced disease. Complete tumor resections are major operations that offer the best chance of long-term disease-free survival. This study analyzes the effect of preoperative anemia and parenteral nutrition on surgical outcomes in these patients undergoing a major liver resection.
Methods: This is a retrospective cohort study of children undergoing a major liver resection for primary malignant hepatic tumors. Data was collected using the National Surgical Quality Improvement Program Pediatric database from 2012-2015. Demographics, comorbidities, and 30-day outcomes were compared by anemia (defined by age-specific clinical practice guidelines) and preoperative total parenteral nutrition (TPN) using Fishers exact test. Outcomes include post-operative complications and hospital readmissions. Propensity score matching was performed to control for significant confounders.
Results: A total of 110 children were included in the study with 80 (72.7%) undergoing lobectomy and 30 (27.3%) trisegmentectomy. The mean age was 3.5 years (range 4 days to 17.7 years). Thirty-one patients (30.4%) were born prematurely with 18 (16.4%) being born before 30 weeks gestational age. 76 (69.1%) patients had preoperative anemia, and 36 (32.7%) were receiving TPN. Children with pre-operative TPN were more likely to have cardiac (p= 0.01), respiratory (<0.01), neurologic (p<0.01), and hematologic co-morbidities (p=0.02). There were 22 (20.0%) post-operative complications and 6 (5.5%) hospital readmissions. After propensity score matching, there were 34 matched pairs for anemia, and 36 matched pairs for TPN. There was no significant difference in post-operative complications between anemic and non-anemic patients (20.6% vs 35.3%, p=0.28). Patients receiving pre-operative TPN had an increased rates of post-operative complications compared to those not (33.3% vs 11.1%, p=0.04). Neither anemia (p=0.61) nor pre-operative TPN use (p=0.05) had a significant association with readmissions.
Conclusion: Anemia and pre-operative TPN are common in children undergoing major resection of primary malignant hepatic tumors, with TPN use being associated with several comorbidities. Patients on pre-operative TPN are at higher risk of complications after surgery and may warrant special attention to their overall conditioning and nutritional status when planning their operation.