Early Predictive Factors for Severe Postoperative Complications Following Major Liver and Pancreatic Surgery

Postoperative severe complications (PSC) are key indicators of surgical quality because they increase healthcare costs, delay adjuvant chemotherapy, and impair long-term survival. Hepato-biliary-pancreatic surgeons perform both liver and pancreatic procedures, which differ substantially in technical complexity; therefore, identifying field-specific risk factors for complications is essential. This study aimed to determine perioperative predictors of PSC following major liver and pancreatic surgery.

This single-center retrospective study included 675 patients who underwent major liver or pancreatic surgery between January 2010 and December 2023 at Gifu University Hospital, Japan. Perioperative variables were analyzed in 328 patients, consisting of those with PSC (n=167; liver n=49, pancreas n=118; Clavien-Dindo ≥III) and those without PSC (n=161; liver n=53, pancreas n=108; Clavien-Dindo

In major pancreatic surgery, PSC were significantly associated with male sex (p=0.01), higher body mass index (p=0.03), smoking history (p=0.02), prior malignancy (p=0.02), respiratory comorbidity (p=0.04), and elevated C-reactive protein to albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) on postoperative day (POD) 3 (p<0.001, p<0.01, and p<0.01). Multivariate analysis identified CAR on POD3 (>5.0) as the sole independent predictor [odds ratio (OR)=4.27; 95% confidence interval (CI)=2.05-9.13; p<0.001]. In major liver surgery, PSC were associated with abnormal CONUT score (p=0.04) and cardiac comorbidity (p=0.04) in univariate analysis, whereas multivariate analysis demonstrated abnormal CONUT score as the only independent predictor (OR=3.40; 95%CI=1.37-8.81; p<0.01).

Postoperative inflammatory markers, particularly CAR on POD3, may function as early indicators of complication severity after major pancreatectomy. Conversely, preoperative nutritional status assessed by CONUT independently predicted PSC following major hepatectomy. These results support inflammation-guided postoperative management in pancreatic surgery and highlight the importance of nutritional optimization before liver surgery.