Post-hepatectomy haemorrhage: A definition and grading by the International Study Group of Liver Surgery (ISGLS)

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Nuh N. Rahbari - , Heidelberg University  (Author)
  • O. James Garden - , University of Edinburgh (Author)
  • Robert Padbury - , Flinders University (Author)
  • Guy Maddern - , University of Adelaide (Author)
  • Moritz Koch - , Heidelberg University  (Author)
  • Thomas J. Hugh - , Royal North Shore Hospital (Author)
  • Sheung Tat Fan - , The University of Hong Kong (Author)
  • Yuji Nimura - , Nagoya University (Author)
  • Joan Figueras - , University of Girona (Author)
  • Jean Nicolas Vauthey - , University of Texas Health Science Center at Houston (Author)
  • Myrddin Rees - , Hampshire Hospitals NHS Foundation Trust (Author)
  • Rene Adam - , Hôpital Paul Brousse (Author)
  • Ronald P. Dematteo - , Memorial Sloan-Kettering Cancer Center (Author)
  • Paul Greig - , University of Toronto (Author)
  • Val Usatoff - , Alfred Health (Author)
  • Simon Banting - , St. Vincent's Hospital Melbourne (Author)
  • Masato Nagino - , Nagoya University (Author)
  • Lorenzo Capussotti - , Institute of Cancer Research and Treatment (Author)
  • Yukihiro Yokoyama - , Nagoya University (Author)
  • Mark Brooke-Smith - , Flinders University (Author)
  • Michael Crawford - , Royal Prince Alfred Hospital (Author)
  • Christopher Christophi - , University of Melbourne (Author)
  • Masatoshi Makuuchi - , The University of Tokyo (Author)
  • Markus W. Büchler - , Heidelberg University  (Author)
  • Jürgen Weitz - , Heidelberg University  (Author)

Abstract

Background: A standardized definition of post-hepatectomy haemorrhage (PHH) has not yet been established. Methods: An international study group of hepatobiliary surgeons from high-volume centres was convened and a definition of PHH was developed together with a grading of severity considering the impact on patients' clinical management. Results: The definition of PHH varies strongly within the hepatic surgery literature. PHH is defined as a drop in haemoglobin level >3 g/dl post-operatively compared with the post-operative baseline level and/or any post-operative transfusion of packed red blood cells (PRBC) for a falling haemoglobin and/or the need for radiological intervention (such as embolization) and/or re-laparotomy to stop bleeding. Evidence of intra-abdominal bleeding should be obtained by imaging or blood loss via the abdominal drains if present. Transfusion of up to two units of PRBC is considered as being Grade A PHH. Grade B PHH requires transfusion of more than two units of PRBC, whereas the need for invasive re-intervention such as embolization and/ or re-laparotomy defines Grade C PHH. Conclusion: The proposed definition and grading of severity of PHH enables valid comparisons of results from different studies. It is easily applicable in clinical routine and should be applied in future trials to standardize reporting of complications.

Details

Original languageEnglish
Pages (from-to)528-535
Number of pages8
JournalHPB
Volume13
Issue number8
Publication statusPublished - Aug 2011
Peer-reviewedYes
Externally publishedYes

External IDs

PubMed 21762295

Keywords

ASJC Scopus subject areas

Keywords

  • complication, haemorrhage, hepatectomy, liver, resection, transfusion