High Arterial Lactate Levels after Hepatic Resection Are Associated with Low Oxygen Delivery and Predict Severe Postoperative Complications

High End-Surgery Arterial Lactate Concentration (ES-ALC) predicts poor outcome after\r\nhepatectomy. The aim of this study was to identify intraoperative hemodynamic parameters\r\npredicting high ES-ALC during elective liver resection. Patients who underwent liver resection\r\nbetween 2017 and 2018, under FloTrac/EV1000TM hemodynamic monitoring, were included. The ESALC cutoff best predicting severe postoperative complications was identified. Association between\r\nhigh ES-ALC and preoperative and intraoperative variables was assessed. 108 patients were\r\nincluded; 90-day mortality was 0.9% and severe morbidity 14.8%. ES-ALC cutoff best\r\ndiscriminating severe complications was 5.05 mmol/L. Patients with ES-ALC > 5.0 mmol/L had a\r\nrelative risk of severe complications of 2.8% (p = 0.004). High ES-ALC patients had longer surgery\r\nand ischemia duration, larger blood losses and higher requirements of fluids and blood\r\ntransfusions. During surgery, hemoglobin concentration and oxygen delivery (DO2) decreased\r\nmore significantly in patients with high ES-ALC, although they had similar values of stroke volume\r\nand cardiac output to those of other patients. At multivariate analysis, surgery duration and lowest\r\nrecorded DO2 value were the strongest predictors of high ES-ALC. ES-ALC > 5.0 mmol/L in elective\r\nliver resection predicts postoperative morbidity and is essentially driven by the impaired DO2.\r\nTimely correction of blood losses might prevent the ES-ALC increase.