Impact of partial hepatectomy versus other major abdominal surgeries on postoperative myocardial injury: a propensity score-matched analysis

BACKGROUND: Partial hepatectomy (PH) may increase the risk of myocardial injury after non-cardiac surgery (MINS), a complication associated with substantial perioperative morbidity and mortality. Direct comparisons of MINS incidence between PH and other major abdominal surgeries (MAS) remain limited. This study evaluated whether PH confers greater risk of postoperative MINS compared with other MAS. METHODS: We conducted a retrospective propensity score-matched cohort study using the INSPIRE database. Adult patients undergoing PH or other MAS between 2011 and 2020 were identified. After 1:2 propensity score matching to minimize confounding, 163 PH patients were compared with 267 matched controls. The primary outcome was MINS incidence. Secondary outcomes included myocardial infarction, heart failure, in-hospital mortality, ICU admission, and hospital length of stay. RESULTS: Following propensity matching, PH patients exhibited significantly higher MINS incidence than controls (44.2% vs. 34.5%; OR = 1.51, 95% CI: 1.01-2.24, P = 0.044). This association was particularly marked in overweight patients, among whom MINS occurred in more than half of PH cases versus approximately one-quarter of controls (52.3% vs. 26.9%; OR = 2.97, 95% CI: 1.37-6.45, P = 0.006). No significant differences emerged in myocardial infarction, heart failure, in-hospital mortality, ICU admission, or hospital length of stay between groups. CONCLUSION: Partial hepatectomy is associated with significantly increased risk of postoperative myocardial injury compared with other major abdominal procedures, particularly among overweight patients.