Preoperative assessment of mortality risk in hepatic resection by clinical variables: A multivariate analysis

Abstract

Hepatic resection is a chance for cure for primary and secondary liver tumors and a variety of benign diseases. Despite advances in surgical technique and patient care, preoperative and postoperative morbidity in patients undergoing liver resection remains high. Because a high morbidity represents a risk factor contributing to a fatal outcome of the surgical procedure, our study aimed to investigate the contribution of different risk factors to a fatal outcome and if mortality can be predicted by the presence of certain risk factors. Two hundred fifty-seven patients undergoing hepatic resection (curative and palliative) were analyzed preoperatively, immediately after surgery, and 10 days after surgery for 60 potential risk factors. Survivors (n = 238) and nonsurvivors (n = 19) were compared univariately. The analysis identified 14 variables to differentiate between groups. These variables were processed by multivariate logistic regression analysis. Three models to estimate 30-day mortality were identified, tested for statistical accuracy, and assessed for their receiver-operated characteristics (ROCs). The variables in the multivariate models were as follows: preoperatively, age, number of comorbid factors, and presence of cirrhosis; immediately after surgery, age, number of comorbid factors, and percentage of resected liver; and 10 days after surgery, age, hours of ventilation, and number of adverse events. Goodness of fit was 0. 863, 0.912, and 0.966, respectively. Areas under the ROC curves were 83.6%, 85.7%, and 98.0%. The specificity (probability to identify survivors correctly) was greater than 90% for all models, although sensitivity (probability to identify nonsurvivors correctly) was greater than 90% only for 10 days after surgery. We conclude that logistic regression is appropriate to assess the importance of risk factors in the course of hepatic resection and to identify patient groups at high risk.

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

“…Mortality following partial hepatectomy in the past two decades still ranges from 0 to 6 %, however, and PHLF has been implicated as contributing to mortality in the majority of cases. 4,12,13 Risk Factors for Post Hepatectomy Liver Failure Identification of the risk factors for PHLF is critical to help identify patients most at risk, as well as to inform strategies aimed at decreasing the incidence and mortality associated with PHLF. Independent predictors of PHLF can be categorized into three main categories: patient-related, liver-related, and surgery/postop-related factors (Table 1).…”

Serum arterial lactate concentration predicts mortality and organ dysfunction following liver resection

“…Factors associated with peri-operative complications and death include patient age [7,8] and gender [9,10], hospital annual number of liver resections undertaken [9,11], pathologic origin of liver tumour [9,11], pre-operative liver and renal dysfunction [8,10], diabetes [12,13], chronic liver disease [7,9], and the peripheral neutrophil to lymphocyte ratio (NLR) [14]. Operative factors associated with outcome include blood loss [8,10] and transfusion [15,16], extent of liver resection [15,17], duration of surgery [18], simultaneous extrahepatic procedures [15,19], and the use of the Pringle manoeuvre [16,20]. …”

Oral glucose tolerance test for preoperative assessment of liver function in liver resection

“…The past decade has seen reduced mortality after hepatic resection to less than 5%, and although the cause of death after hepatic resection is multifactorial, PLF seems to be the main cause 8. A great number of hepatic resection have been mainly reported from the Western countries and the Far East.…”

“…The reported incidence of PLF ranges between 0.7% and 9.1% 12456. Over the years, mortality after liver resection ranged from 0 to 5%, and although multifactorial, PLF seems to be the main cause (18-75%) 789…”