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A Point-Based Risk Calculator for Mortality After Hepatectomy.

Tiffany Luu1, Brian P Curran, Alvaro A Macias

  • 1From the Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California.

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|June 12, 2023
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Summary

This study developed a new risk calculator to predict 30-day mortality after hepatectomy surgery. The tool uses preoperative factors to help surgical teams improve patient planning and care.

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Clinical Risk Prediction

Background:

  • Hepatectomy, a major liver surgery, carries significant risks.
  • Accurate preoperative risk stratification is crucial for informed clinical decision-making.
  • Identifying mortality risk factors aids in surgical planning and patient management.

Purpose of the Study:

  • To identify preoperative risk factors for 30-day postoperative mortality in hepatectomy patients.
  • To develop a score-based risk calculator for estimating mortality risk.
  • To enhance clinical decision support for patients undergoing hepatectomy.

Main Methods:

  • Retrospective cohort study using the National Surgical Quality Improvement Program dataset (2014-2020).
  • Data split into training (n=26,397) and testing (n=12,164) sets.
  • Multivariable logistic regression used to develop a point-based risk calculator based on nine independent preoperative predictors.

Main Results:

  • Identified nine independent predictors of postoperative mortality: age, diabetes, sex, sodium, albumin, bilirubin, SGOT, INR, and ASA score.
  • Developed a risk calculator with an Area Under the Receiver Operating Characteristic curve (AUC) of 0.719 on the test set.
  • The calculator assigns points based on odds ratios of identified risk factors.

Conclusions:

  • A novel, score-based risk calculator for predicting 30-day mortality after hepatectomy has been developed.
  • This tool can potentially improve transparency in surgical and anesthesia planning.
  • Facilitates better patient support and management for those undergoing liver resections.