Preoperative risk score for 90-day mortality after major liver resection
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Major liver resection is frequently performed for primary and secondary liver tumors. However, 90-day mortality rates can exceed 10% in high-risk patients. This study aimed to develop a preoperative risk score for postoperative mortality after major liver resection. METHODS: All major liver resections between 2014 and 2019 in 2 Dutch tertiary referral centers were identified. A validation cohort consisted of all consecutive patients who underwent a major liver resection in the nationwide Dutch Hepato Biliary Audit from 2014 to 2020. Multivariate logistic regression was used to identify prognostic factors and develop a mortality risk score. RESULTS: Major liver resection was performed in 513 patients, of whom 238 (46.4%) had a primary liver cancer, and in 148 patients (28.8%), a hepaticojejunostomy was performed; 90-day mortality occurred in 56 patients (10.8%). Mortality was independently predicted by 5 risk factors: age ≥ 65 years, diabetes mellitus type 2, diagnosis of primary liver cancer, American Society of Anesthesiologists ≥ 3, and extended hemihepatectomy. A risk score with 1 point assigned to each risk factor showed good discrimination (area under the curve [AUC], 0.77; 95% CI, 0.71-0.83). The predicted 90-day mortality was 3.5% for low-risk (0 or 1 points; 53.8% of all patients), 11.1% for intermediate-risk (2 points; 25.3%), and 29.7% for high-risk patients (3-5 points; 20.9%). External validation in the nationwide cohort with 1617 patients showed similar concordance (AUC, 0.69; 95% CI, 0.64-0.75). CONCLUSION: The proposed and validated risk score can aid in shared decision making.
Authors: Sebastiaan Ceuppens, Pim B. Olthof, Arthur K.E. Elfrink, Stijn Franssen, Rutger-Jan Swijnenburg, Joost M. Klaase, Maarten W. Nijkamp, Frederik J.H. Hoogwater, Andries E. Braat, Jeroen Hagendoorn, Wouter J.M. Derksen, Peter B. van den Boezem, Paul D. Gobardhan, Marcel den Dulk, Maxime J.L. Dewulf, Mike S.L. Liem, Wouter K.G. Leclercq, Eric J.T. Belt, Koert F.D. Kuhlmann, Niels F.M. Kok, Hendrik A. Marsman, Dirk Jan Grünhagen, Joris I. Erdmann, Bas Groot Koerkamp
Institutions: Erasmus MC, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Dutch Institute for Clinical Auditing, University Medical Center Groningen, Leiden University Medical Center, University Medical Center Utrecht, St. Antonius Ziekenhuis, Radboud University Medical Center, Amphia Ziekenhuis, Maastricht University Medical Centre, Maastricht University, Medisch Spectrum Twente, Máxima Medisch Centrum, Albert Schweitzer Ziekenhuis, The Netherlands Cancer Institute, OLVG
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,950
OpenAlex ID: W4409539150