Preoperative Risk Score Predicting 90-Day Mortality After Liver Resection in a Population-Based Study

Abstract

The impact of important preexisting comorbidities, such as liver and renal disease, on the outcome of liver resection remains unclear. Identification of patients at risk of mortality will aid in improving preoperative preparations. The purpose of this study is to develop and validate a population-based score based on available preoperative and predictable parameters predicting 90-day mortality after liver resection using data from a hepatitis endemic country.We identified 13,159 patients who underwent liver resection between 2002 and 2006 in the Taiwan National Health Insurance Research Database. In a randomly selected half of the total patients, multivariate logistic regression analysis was used to develop a prediction score for estimating the risk of 90-day mortality by patient demographics, preoperative liver disease and comorbidities, indication for surgery, and procedure type. The score was validated with the remaining half of the patients.Overall 90-day mortality was 3.9%. Predictive characteristics included in the model were age, preexisting cirrhosis-related complications, ischemic heart disease, heart failure, cerebrovascular disease, renal disease, malignancy, and procedure type. Four risk groups were stratified by mortality scores of 1.1%, 2.2%, 7.7%, and 15%. Preexisting renal disease and cirrhosis-related complications were the strongest predictors. The score discriminated well in both the derivation and validation sets with c-statistics of 0.75 and 0.75, respectively.This population-based score could identify patients at risk of 90-day mortality before liver resection. Preexisting renal disease and cirrhosis-related complications had the strongest influence on mortality. This score enables preoperative risk stratification, decision-making, quality assessment, and counseling for individual patients.

Recent trends in postoperative mortality after liver resection- A systemic review and metanalysis of studies published in last 5 years and metaregression of various factors affecting 90 days mortality

“…There is also wide regional variations in indications of liver resections. In Asian countries most common indication is hepatocellular carcinoma [54] while in European countries most common indications is colorectal metastasis, which can also be reason of variable mortality following liver resection. Our Aim in conducting this systemic review and prevalence meta-analysis to study weighted post-operative mortality rates after liver resections.…”

Skurðmeðferð lifrarfrumukrabbameins á Landspítala 1993-2012

“…Í heildina greindust 105 einstak-lingar með lifrarfrumukrabbamein, 6 fóru í lifrarígraeðslu og alls gengust 28 (27%) einstaklingar undir skurðaðgerð. Meðalstaerð aexla var 8,5 cm (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Fjórir einstaklingar voru með skorpulifur.…”

“…18 Helstu forspárþaettir fyrir skurðdauða eru undirliggjandi nýrnasjúkdómur og skorpulifur. 19,20 Fimm ára lifun eftir lifrarbrottnám vegna lifrarfrumukrabbameins er 26-55% samkvaemt erlendum rannsóknum en endurkomutíðni er há, eða allt að 80% innan 5 ára. 21 Áhaettuþaettir fyrir endurkomu eru staerð aexlis, aexli í eða nálaegt skurðbrún, skorpulifur, innvöxtur aexlis í aeðar, aexli af hárri gráðu, fjöldi hnúta og smáaeða segamyndun.…”

Surgical resection of localized hepatocellular carcinoma: patient selection and special consideration

“…Treatment options for HCC are largely inferred by patient, livers, and tumor factors at presentation and these factors form the backbone of a number of well-adopted treatment algorithms (Table 2). 59–63 The association between general health condition and prognosis of HCC had been well documented 22,59,64–67. In general, patients with poor cardiopulmonary function, limited life expectancy, or poor quality of life (i.e., bedridden and noncommunicable) due to underlying medical comorbidities are not a surgical candidate.…”