Risk assessment for liver resection.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Medical Informatics

Background:

• Patient profiles for complex liver resections are evolving.
• Mortality rates after hepatectomy have remained stable.
• Identifying high-risk patients for postoperative mortality is crucial.

Purpose of the Study:

• To evaluate variables associated with surgical outcomes after hepatectomy.
• To identify patient groups at high risk for postoperative mortality.
• To develop and validate a predictive risk score for 90-day mortality.

Main Methods:

• Analysis of 1,796 patients undergoing liver resection (more than one segment).
• Logistic regression to identify risk factors for 90-day in-hospital mortality.
• Development and external validation of a 90-day mortality-risk score.

Main Results:

• Key mortality risk factors include age ≥60, ASA IV, cholangiocarcinoma, elevated INR, g-GT, creatinine, and right trisectionectomy.
• The developed risk score accurately stratified patients into mortality risk groups (very low to high).
• The risk score demonstrated strong predictive performance with C-indices of 0.86 (internal) and 0.89 (external validation).

Conclusions:

• A novel preoperative risk score, based on patient and procedure variables, can identify patients at high risk for 90-day mortality after liver resection.
• This risk score aids in surgical planning and patient management.
• The score's effectiveness was confirmed through external validation.