From the Guidelines
A partial hepatectomy typically does not require an ICU stay for most patients. After surgery, most patients are monitored in a regular surgical ward unless they have significant comorbidities, extensive liver resection, or complications during surgery. The typical hospital stay for an uncomplicated partial hepatectomy ranges from 3-7 days, with patients being transferred to the regular floor after initial recovery in the post-anesthesia care unit. However, certain factors may necessitate ICU admission, including major blood loss during surgery (>1500 mL), extended operative time, hemodynamic instability, respiratory complications, pre-existing severe cardiac or pulmonary disease, or if the patient underwent a complex or extensive liver resection (such as extended right or left hepatectomy).
According to the guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations 2022 1, the focus is on optimizing the patient's condition before surgery, which can reduce the need for ICU admission. For example, preoperative smoking cessation should be counseled at least 4 weeks prior to hepatectomy, and alcohol cessation is recommended for heavy drinkers 4–8 weeks before surgery 1. Additionally, a nutritional assessment is necessary prior to all hepatic surgery, and malnourished patients should be optimized with enteral supplementation at least 7–14 days prior to surgery 1.
The decision for ICU admission is individualized based on the patient's overall condition, the extent of liver resection, and institutional protocols. Modern enhanced recovery after surgery (ERAS) protocols have further reduced the need for routine ICU stays after partial hepatectomy by emphasizing early mobilization, optimized pain management, and early oral feeding. Key aspects of ERAS protocols, such as preoperative carbohydrate loading and anti-thrombotic prophylaxis, can help minimize complications and support the patient's recovery in a regular surgical ward 1.
Some key considerations for ICU admission include:
- Major blood loss during surgery (>1500 mL)
- Extended operative time
- Hemodynamic instability
- Respiratory complications
- Pre-existing severe cardiac or pulmonary disease
- Complex or extensive liver resection (such as extended right or left hepatectomy) These factors should be carefully evaluated, and the decision for ICU admission should be made on a case-by-case basis, taking into account the patient's individual needs and the institution's resources and protocols.
From the Research
Post-Operative Care for Partial Hepatectomy
- The need for a stay at the ICU after a partial hepatectomy is not explicitly stated in the provided studies, but the complexity of the surgery and potential post-operative complications suggest that ICU care may be necessary for some patients 2, 3, 4.
- Studies have shown that partial hepatectomy can be a safe and effective treatment for various liver diseases, but it is still associated with relatively high rates of postoperative morbidity and mortality 2, 3.
- The management of post-hepatectomy complications is crucial to improving patient outcomes, and enhanced recovery after surgery (ERAS) clinical pathways may be beneficial in reducing postoperative complications and length of stay 5.
- Heparin administration has been shown to reduce the risk of posthepatectomy liver failure and improve short-term postoperative outcomes, which may impact the need for ICU care 6.
Potential Complications Requiring ICU Care
- Postoperative hemorrhage, venous thromboembolism, bile leak, and post-hepatectomy liver failure are potentially devastating complications of liver resection that may require ICU care 4.
- The risk factors and management of these complications are critical to identifying preoperative factors that can decrease the risk for these potentially fatal complications 4.
- ICU care may be necessary for patients who experience these complications, and heparin administration may be a useful treatment for preventing liver failure 6.