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Predicting morbidity of liver resection.

Sudharsan Madhavan1, Vishal G Shelat2, Su-Lin Soong2

  • 1Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Republic of Singapore.

Langenbeck'S Archives of Surgery
|February 9, 2018
PubMed
Summary

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator is more effective than POSSUM for predicting post-operative morbidity after liver resection (LR). This finding aids in better patient risk assessment for liver surgery.

Keywords:
ACS-NSQIPLiver resectionModelMorbidityPOSSUM

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Outcomes Research
  • Predictive Modeling in Medicine

Background:

  • Accurate prediction of post-operative morbidity is crucial for liver resection (LR) patients.
  • Existing models like POSSUM have limitations in predicting LR outcomes.
  • The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator offers a potential alternative.

Purpose of the Study:

  • To compare the efficacy of the ACS-NSQIP surgical risk calculator and the Physiological and Operative Severity Score in the enUmeration of Mortality and Morbidity (POSSUM) in predicting post-operative morbidity following LR.
  • To evaluate the predictive performance of both scoring systems in patients undergoing liver resection.

Main Methods:

  • Retrospective analysis of patients undergoing elective liver resection.
  • Calculation of morbidity risk using ACS-NSQIP and POSSUM scoring systems.
  • Comparison of discrimination, calibration, and overall performance between ACS-NSQIP and POSSUM models, including logistic regression-derived models.

Main Results:

  • The study included 245 patients undergoing LR, with 91% having malignant liver pathologies.
  • Post-operative morbidity was 38.3%, with 90-day and 30-day mortality rates of 3.7% and 2.4%, respectively.
  • The ACS-NSQIP calculator demonstrated superior discriminative ability, calibration, and performance compared to POSSUM (p=0.03), with a better fit shown by the Hosmer-Lemeshow plot.

Conclusions:

  • The ACS-NSQIP surgical risk calculator is a superior tool for predicting morbidity risk in patients undergoing liver resection compared to POSSUM.
  • These findings support the use of the ACS-NSQIP calculator for improved risk stratification in LR patients.