Is It Feasible to Standardize a Composite Postoperative Complication Reporting System for Liver Resection?

Although the Clavien-Dindo classification is well established in many fields of surgery, a conclusive severity grading system for liver surgery-specific complications has not yet been standardized. Post-hepatectomy liver Failure, Ascites, Bile leakage, Infection, and Bleeding were found to be the five most important components in an international survey. A score system with FABIB as the acronym was proposed by the authors to increase the feasibility of routine use.

The definition and grading of three components ("liver failure," "bile leakage," and "bleeding") were adopted from the International Study Group for Liver Surgery. The definition and grading for "ascites" as well as "infection" were proposed by the authors. The postoperative complications were documented prospectively. The data from 2012 to 2016 were reviewed and the correlations to other clinical parameters were analyzed retrospectively.

Five hundred one consecutive liver resections were assessed. Two hundred twenty-four (44.7%) patients had at least one postoperative complication of the FABIB system. The FABIB score was found to correlate with the operation complexity (major vs minor liver resection, with or without biliodigestive anastomosis), underlying liver disease (normal liver parenchyma vs fibrosis vs cirrhotic liver), 90-day mortality (statistically significantly different within three predefined categories), and the length of hospital stay (the mean value increases proportionately to FABIB score).

Using the FABIB reporting system, the five main complications after liver surgery can be documented in a standardized manner. Its clinical relevance might increase the feasibility and comparability of studies or trials in liver surgery.