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Prediction of postoperative complications after hepatectomy with dynamic monitoring of central venous oxygen saturation 中心静脈血酸素飽和度の動的モニタリングによる肝切除術後合併症予測に関する検討 井田, 進也 イダ, シンヤ Ida, Shinya open access (C) The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons. org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Flo Trac System Central venous oxygen saturation Hepatectomy Comprehensive complication index Anesthetic management doctoral 医学系研究科 Background　The usefulness of static monitoring using central venous pressure has been reported for anesthetic management in hepatectomy. It is unclear whether intra-hepatectomy dynamic monitoring can predict the postoperative course. We aimed to investigate the association between intraoperative dynamic monitoring and post-hepatectomy complications. Furthermore, we propose a novel anesthetic management strategy to reduce postoperative complication. Methods　From 2018 to 2021, 93 patients underwent hepatectomy at our hospital. Fifty-three patients who underwent dynamic monitoring during hepatectomy were enrolled. Flo Trac system was used for dynamic monitoring. The baseline central venous oxygen saturation (ScvO2) was defined as the average ScvO2 for 30 min after anesthesia induction. ScvO2 fluctuation (ΔScvO2) was defined as the difference between the baseline and minimum ScvO2. Postoperative complications were evaluated using the comprehensive complication index (CCI). Results　Patients with ΔScvO2 ≥ 10% had significantly higher CCI scores (0 vs. 20.9: p=0.043). In univariate analysis, patients with higher CCI scores demonstrated significantly higher preoperative C-reactive protein-to-lymphocyte ratio (7.51 vs. 24.49: p=0.039), intraoperative bleeding (105 vs. 581 ml: p=0.008), number of patients with major hepatectomy (4/45 vs. 3/8: p=0.028), and number of patients with ΔScvO2 ≥ 10% (11/45 vs. 6/8; p=0.010). Multivariate logistic regression analysis revealed that ΔScvO2 ≥ 10% (odds ratio: 9.53, p=0.016) was the only independent predictor of elevated CCI. Conclusions　Central venous oxygen saturation fluctuation during hepatectomy is a predictor of postoperative complications. Anesthetic management based on intraoperative dynamic monitoring and minimizing the change in ScvO2 is a potential strategy for decreasing the risk of post-hepatectomy complications. Springer Nature 2023-11-14 eng doctoral thesis VoR http://hdl.handle.net/10271/0002000322 https://hama-med.repo.nii.ac.jp/records/2000322 37957615 https://doi.org/10.1186/s12893-023-02238-6 1471-2482 AA1203545X BMC Surgery 23 343 甲第975号 博士（医学） 2024-03-13 13802 浜松医科大学 Hamamatsu University School of Medicine https://hama-med.repo.nii.ac.jp/record/2000322/files/DT_975ronbun.pdf application/pdf 1 MB 2025-01-14