Predictors of Postoperative Morbidity in Hepatic Hemangioma Surgery: A Single-Center Experience

Background and Objectives: Hepatic hemangioma is the most common benign liver tumor and is usually managed conservatively. When surgical treatment is indicated, accurate preoperative risk assessment is important because surgery is elective and aims to relieve symptoms while minimizing postoperative morbidity. This study aimed to identify preoperative predictors of postoperative morbidity following hepatic hemangioma resection. Materials and Methods: This retrospective cohort study included 274 consecutive patients who underwent elective hepatic resection for hepatic hemangioma at a tertiary hepatobiliary referral center between January 2002 and December 2024. Demographic, clinical, and operative variables were analyzed. Independent predictors of postoperative morbidity were identified using multivariable binary logistic regression. Model discrimination was assessed by receiver operating characteristic curve analysis, and internal validation was performed using bootstrap resampling. Results: Persistent abdominal pain was the most frequent indication for surgery (77.0%) and was significantly more common with increasing tumor size (p < 0.001). Maximum tumor diameter (OR 1.329, 95% CI 1.188-1.486; p < 0.001), ASA Physical Status Classification (OR 1.791, 95% CI 1.167-2.750; p = 0.008), and Charlson Comorbidity Index (OR 1.342, 95% CI 1.015-1.774; p = 0.039) were independently associated with postoperative morbidity. Age, sex, and operative approach were not independently associated with postoperative morbidity. The model demonstrated satisfactory calibration (Hosmer-Lemeshow p = 0.245) and good apparent discrimination (AUC 0.783, 95% CI 0.722-0.845; p < 0.001). The optimism-corrected AUC after internal bootstrap validation was approximately 0.732. Conclusions: Tumor size, ASA Physical Status Classification, and Charlson Comorbidity Index independently predicted postoperative morbidity after hepatic hemangioma resection. Their integration may provide a practical preoperative risk-stratification framework for patients being considered for elective hepatic hemangioma surgery. However, external validation in independent cohorts is required before broader clinical application.